Medicare Set Aside


Disabled Workers Advocates provides customers with access to a comprehensive MSP solution of Medicare compliance services for the Workers’ Compensation and Liability markets inclusive of Medicare Set Asides, Lien & Conditional Payment Negotiations, and CMS submission and approval management.

Our Medicare Set Aside’s create a measure of guidance on settlement language, strategy, and justification of the MSA amount. We provide clients with an integrated Medicare Compliance Service Program focused on reducing claim cost, positioning a claim for settlement, and promoting compliance.

Medicare Set Aside Allocation

  • Workers’ Compensation, Liability, and Auto No Fault claims
  • Comprehensive overview of future care recommendations related to the accepted injuries of a claim
  • Accurate forecasting of future care cost projections leveraging State Fee Schedule & UCR Pricing
  • Prepare Medical Cost Projection Allocation report in accordance with CMS Guidelines
  • Annuity Quotes as applicable
  • Effective & Efficient Turnaround Time

Rated Age Request

Incorporates an actuary that may impact life expectancy and the Medicare Allocation Amount

Medicare Set Aside Legal Submission

  •  The assembly of a MSA Arrangement and the submission to Medicare for review and approval
  • Update claimant’s eligibility status for Social Security and Medicare benefits
  • Advise on method of funding, administering MSA, and Settlement Allocation language

Medicare Conditional Payment Lien Analysis & Negotiations

Negotiation process with Medicare to exclude non-related conditional payments or reduce lien amount on conditional payments related to a compensable injury

Medical Cost Projection

The Medical Cost Projection provides a comprehensive and cost-effective solution designed to forecast future medical exposure and establish an accurate basis upon which to set reserves and identify cost drivers

Prospective (Pre) MSA Review

Initial review of Treatment Plan with focus on RX to determine if it aligns with relevant evidence based guidelines or other Best Practices inclusive of implementation of revised RX treatment plan regimen

Post Settlement Fund Administration

MSA services shown above will only be completed if requested by the Claims Adjuster