Medicare Set-Aside

Daugherty & Associates, LLC
Medical-Legal Nurse Consulting

Medicare Set-Aside Allocations

The Medicare Set Aside Program is federal legislation designed to prevent the shifting of responsibility for medical treatment from a primary payor or insurance carrier to Medicare.

The Medicare Set Aside Amount will be an amount of money set aside in an account to cover the expenses of an injured worker. This amount is based on the following and is reviewed by the Centers for Medicare and Medicaid Services for approval:
    - Comprehensive review of the medical records
    - Review of medical claim history
    - Physician recommendations
    - Standards of care

This money is in an individual account and can only be used for the medical expenses that Medicare would usually cover had it not been a work injury.

Our Medicare Set-Aside Allocators can determine the appropriate set-aside amount based on:
    - An expert analysis of the condition
    - Current treatment
    - Projected future treatment
    - Life expectancy

Medicare Set-Aside Allocations include several components:
    - Medicare Set-Aside Arrangement (MSA)
    - Medicare confirmation / lien verification (conditional payments)
    - Submission to the Center for Medicare and Medicaid Services (CMS)
    - Professional administration of the MSA

Daugherty & Associates, LLC can assist you by:

- Determining Social Security / Medicare eligibility
- Verifying Medicare lien (conditional payment) status
- Researching and formulating the Medicare allocation amount
- Submitting the MSA to Center for Medicare and Medicaid Services (CMS) for approval
- Coordinating with Attorneys, settlement Brokers and CMS throughout the approval of the allocation