RN CASE MANAGEMENT
VOCATIONAL/RTW
PREAUTHORIZATION
PEER REVIEW
MEDICAL BILL REVIEW
LIFE CARE PLANNING
CONSULTING


 

Click to see if you need an MSA

MSA Referral Form

The Medicare Secondary Payer (MSP) statute is having a significant impact on workers' comp and liability claim settlements. Compliance with the statute can be a cumbersome, if not bewildering, process that carries financial and liability risks if not carried out properly.

It is critical to take the MSP statute into consideration when a claim settlement meets certain thresholds. Primary payers in workers' compensation and liability must determine whether a Medicare Set-Aside Arrangement (MSA) is indicated and whether it requires approval by the Centers for Medicare & Medicaid Services (CMS).

Failure to take the right steps can result in stiff penalties, including denial of future Medicare payments to the claimant, and liability and substantial fines for the employer, insurance carrier, and attorneys.

As a long-time trusted resource in workers' comp and liability, Systemedic can help you manage compliance with the Medicare Secondary Payer statute and set up, submit, fund, and administer your MSA. 

Our MSA professionals offer the following services:

MSA Analysis and Report

• Review records of prior medical care & expenses

• Prepare MSA analysis & cost projections

• Obtain Rated Age life expectancy (when appropriate)

• Provide legal analysis

• Recommend MSA funding options

• Prepare comprehensive MSA report for your review and to be used in any submissions to CMS.
  (Upon request, we can make the submission to CMS for you.)

Submission to CMS

• Collection of CMS required documentation

• Preparation of report and financial instruments

• Submission to CMS for approval

MSA Funding

• Implementation of one of the selected funding options proposed in our MSA report

Post-settlement Administration

• Education of claimant regarding Medicare covered expenses and proper procedures

• Reduction to state fee schedule and payment from MSA account of Medicare-eligible medical expenses for claimant

• Annual reporting to CMS for claimant

• Distribution of MSA account balances upon death of claimant

To inquire about Systemedic's MSA services, call 501.227.5553 or 800.822.2680, or email MSA@systemedic.com .

To submit a referral, print and complete the PDF Referral Form below and return to Systemedic by mail, fax or email:

Systemedic MSA Services
10809 Executive Center Drive, STE. 105
Little Rock, AR 72211

Phone: 501-227-5553 or 800.822.2680
Fax: 501.227.8362
Email: MSA@systemedic.com

• MSA Referral Form

The following forms are provided for your convenience, if you need them:

• Social Security Consent Form

• CMS Consent Form

• Request for Medicare & SS Status