Medicare Set Aside Arrangements


Our services are designed to be a cost-effective approach, jurisdictional specific, and provides information to assist all parties to work together to promote appropriate financial resolution for each case.

Due to the recent enforcement of the Medicare Secondary Payer Act, The Wright Rehabilitation Services, Inc. has designed a package of medical review services to meet the needs of our clients: Insurance Companies, Third Party Administrators, Employers, Attorneys, Brokers, etc.

Medicare Set-Aside Arrangements must be completed, and approved by the Centers for Medicare and Medicaid Services (CMS) when:

 

  • The injured worker is currently a Medicare beneficiary and the total settlement amount exceeds $25,000.

  • The injured worker has a reasonable expectation of Medicare enrollment within 30 months of the settlement date and the total settlement amount exceeds $250,000.

  • If the injured worker is not a Medicare beneficiary:

  • . Applied for SSDB

  •  Denied SSDB but anticipate an appeal

  •  Is 62 ½ years of age

  • .Has End-Stage Renal Disease (ESRD)

 

Life Care Plans/Future Care Plans:
Life Care Plans or Future Care Plans are comprehensive documents that attempt to delineate future rehabilitation care needs for individuals with catastrophic or complicated injuries or disease. Life Care Plans are supported by extensive research, which substantiates the recommendations, provides factual documentation of community resources, and lists customary costs for services in a specific geographic region. WRS obtains future medical cost projections from the physicians involved in the case rather than just a review of retrospective medicals. The information is then compiled into reports that are presented in an annual and lifetime format.

Life Care Plans with Medicare Set-Aside Arrangement:
A Life Care Plan with a Medicare Set-Aside Arrangement for a workers' compensation case may not necessarily warrant all of the documentation required for the aforementioned Life Care Plan/Future Care Plan product. A life care plan used to document what an MSA does not cover is often requested to accompany an MSA.