Specialty Allocations offers professional administration services for cases involving a Medicare Set Aside (MSA) for attorneys and adjusters representing Workers’ Compensation, General Liability, and Personal Injury cases. We maintain compliance with the Medicare Secondary Payer (MSP) statute, applicable Centers for Medicare and Medicaid Services (CMS) guidelines, and to take any other actions to “reasonably protect Medicare’s interest” in the form of a Medicare Set Aside Custodial Account. Specialty Allocations strives to serve as a reliable resource for the injured worker.
Whether the Medicare Set Aside is approved or not, an agreed upon amount is deposited into an interest bearing, FDIC insured account. These funds are administered through Specialty Allocations’ case management process that utilizes cost saving tools to “extend” the funds of the account over a longer period of time.
Specialty Allocations assures that any payments for medical expenses related to the original accident or incident are paid out of the fund and not submitted to Medicare. During the term of the agreement, Specialty Allocations will work with you and your health provider to assure that payments from your Medicare Set Aside Custodial Account meet two critical criteria (1) that they are related to the injuries or illness resulting from the original accident and (2) that the funds are used to pay “Medicare allowable” expenses.
Specialty Allocations assigns a professional and experienced case manager whose responsibility is to work with the client and their medical provider(s) to assure that all payments from the fund meet the above criteria and assist in getting the best treatment, medication and devices at the best price.
Specialty Allocations will provide annual statements to the claimant and, if required, to the COBC.
Medicare Set Aside Custodial Account Service Components:
- Medicare Set Aside funds are deposited into an interest bearing account. Each claimant’s fund is in a separate account, there is no pooling of funds. 100% of interest earned goes back to the fund. Quarterly reports are sent to the claimant and/or claimant’s family regarding the account transactions.
- A Disability Nurse Case Manager (DNCM) is assigned to each case. The DNCM monitors the case and manages the providers’ billing. The DNCM will be the claimant's advocate and will assist with appointments and all medical providers pertaining to the injuries sustained related to the accident.
- Each new claimant receives a membership card to present to providers so that the providers will contact the DNCM regarding the claimant’s course of treatment.
- A discount pharmacy network is utilized for mail order pharmaceuticals which can save up to 40% in prescription medication costs. DNCM will monitor all prescribed medications involved.
- A discount diagnostic network is applied for MRI, CT, other tests, and durable medical equipment (DME).
- All medical bills are reviewed to properly allocate to either the Workers’ Compensation fee schedule or to usual & customary fee schedule.
- In addition to the above, other medical cost containment tools are provided in order to “extend” the funds of the account over a longer period of time.
- Annual Accounting is submitted to CMS pertaining to all provider/medical costs during each calendar year as required by CMS.
- No contractual changes to the fees during the term of our agreement.
Did you know that Specialty Allocations’ Medicare Set Aside Custodial Account can help save your client money? Here’s how:
- Medical Bill Review: All medical bills will be analyzed to ensure accuracy. This includes making sure the bills are compliant with your state’s workers’ compensation fee schedule. If a workers’ compensation fee schedule is not applicable, we will analyze the bills for errors, overcharges, and Medicare compliance.
- Discount Pharmacy Program and Discount Diagnostic Network: We are a part of a large network of companies that get discounts on medical expenses not available to individuals. This network is designed to achieve savings and stretch settlement dollars. Currently, 75% of all pharmacies are listed in the network and offer a discount card for the claimant to use. Mail order will be available upon request. The Diagnostic Network offers MRI, CT Scans and other diagnostic tools at a discounted rate.
- Negotiation Services: Our medical professionals will be available to collaborate with your medical providers in order to negotiate the cost of treatment. We will review the bills for any discrepancies.