CMS SUBMISSIONS

Specialty Allocations sends Medicare Set Aside proposals to CMS upon the request of the referral source. A cover letter is generated notifying of the submission. We provide ongoing status updates of the submission until a decision is reached by CMS.

 

Submitting a Medicare Set Aside to CMS for Approval

 

CMS’s Review Thresholds for WCMSAs:

Medicare Set Asides are recommended for submission to CMS when they meet the following criteria:

  • The claimant is a Medicare beneficiary and the total settlement amount is greater than $25,000.00; or
  • The claimant has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the anticipated total settlement amount for future medical expenses and disability/lost wages over the life or duration of the settlement agreement is expected to be greater than $250,000.00.

 

A claimant has a reasonable expectation of Medicare enrollment within 30 months if any of the following apply:

 

  • The claimant has applied for Social Security Disability Benefits
  • The claimant has been denied Social Security Disability Benefits but anticipates appealing that decision
  • The claimant is in the process of appealing and/or re-filing for Social Security Disability benefits
  • The claimant is 62 years and 6 months old
  • The claimant has an End Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD.

 

For MSAs that meet the mentioned criteria, we will send a Medicare Set Aside proposal to CMS upon the request of the referral source.  A cover letter is always given to the referral source for their record keeping. We follow up with our proposals every two weeks until an approval is obtained.

 

Specialty Allocations

555 Winderley Place, Suite 300

Maitland, FL 32751

Have Questions?

Phone: 866-881-4143