Advanced Disability Management (ADM) is a leading provider of Medicare Set-Aside Arrangement (MSA) services. We utilize a team of trained professionals which include NAMSAP Certified MSA Specialists, Certified Life Care Planners, Medical Case Managers, Vocational Rehabilitation Counselors and Physicians to complete the MSA report. This multi-specialist process results in a more accurate, higher quality report and a quicker turn-around time for our customers.

MSA Service Includes:

  • Future medical treatment covered by Medicare
  • Future prescription drug treatment covered by Medicare
  • Future non-Medicare covered treatment
  • Inquiry into Medicare Conditional Payment (lien) status
  • Submission to CMS for approval
  • Expedited MSA completion
  • National coverage
  • Certified professionals with appropriate credentials
  • MSA reports peer reviewed for quality assurance
  • Easy referral process: phone, fax, e-mail/Web

The ADM Difference

  • Quick turn-around-time for MSA report.
  • Customer Service Representatives available in most areas to come to your office, answer eligibility questions, assist with the referral process and copy the necessary medical and payout history reports.
  • Over 20 years of Disability Management experience providing services to the Workers’ Compensation industry which includes the review of Workers Compensation claims for medical necessity and future medical care cost projections.
  • Provide our customers the assurance that they are receiving the lowest defensible future medical cost projection on their claim.
  • Medicare Part D/Prescription Drug Coverage Expertise.

MSA Recommended but CMS Review Not Required

  • The settlement of the claim will close or limit future medical benefits.
  • The claimant is already a Medicare beneficiary but the total settlement amount is $25,000 or less.
  • The claimant is not yet a Medicare beneficiary but has a “reasonable expectation” of Medicare enrollment within 30 months of the date of settlement.

Situations where an individual has a “reasonable expectation” of Medicare enrollment within 30 months include, but are not limited to:

  • The individual has applied for Social Security Disability Insurance (SSDI) benefits;
  • The individual has been denied SSDI benefits but anticipates appealing that decision;
  • The individual is in the process of appealing and/or re-filing for SSDI benefits;
  • The individual is 62 years and 6 months old (i.e., may be eligible for Medicare based upon his/her age within 30 months);
  • The individual has an End Stage Renal Disease (ESRD) condition but does not yet qualify for Medicare based upon ESRD.

MSA Required & Approval by CMS

The Centers for Medicare & Medicaid Services (CMS) has established the following review thresholds indicating when an MSA is both required and approval is needed when settling a Workers’ Compensation (WC) claim which is closing out the future medical expenses:

  • If the claimant is already a Medicare beneficiary at the time of settlement, then a CMS reviewed MSA is required when the total settlement amount is greater than $25,000, or
  • If the claimant is not yet a Medicare beneficiary then both of the following must be present for a CMS reviewed MSA to be appropriate:
    • The total settlement amount exceeds $250,000 AND
    • The claimant has a “reasonable expectation” of Medicare enrollment within 30 months of the date of settlement.

“IMPORTANT” CMS has also stated there is no “Safe Harbor” for complying with the Medicare Secondary Payer (MSP) statute. Thus, even if review thresholds are not met, Medicare’s interests must always be considered when settling any workers’ compensation case. ADM will assist in determining when an MSA should be completed in all situations in order to protect the parties from future liability.