How to Manage Medicare Set-Asides: Tips from Dan Anders

May 29, 2024

Manage Medicare Set Asides

Our Chief Compliance Officer Dan Anders learned how to write Medicare Set-Asides (MSA) the hard way through trial and error in the days before the Centers for Medicare and Medicaid published complete guidelines.  Even now, the manuals and regulations don’t cover every detail.

And with MSAs details matter.  Proper documentation, down to the way the claimant signs and initials their consent form, is essential.  Dan compiled some tips for managing MSAs with CMS in his May 21 Leaders Speak article for WorkCompWire. These are among the topics covered:

Rated ages

The article highlights the use of rated ages as a way to calculate a fair allocation for the MSA.  Briefly, if an injured worker has comorbidities that will likely reduce their longevity, a rated age can reduce the allocation of the MSA.

How to respond to a dreaded Development Letter from CMS

Dan tells readers how to respond to a CMS Development Letter, which CMS sends when it needs additional information to review submitted MSA. These letters usually request updated treatment records, complete claim payment history of medical, indemnity and expenses, or a document that clearly outlines all the dates of injuries, all carriers, and all accepted and denied body parts.

Development letters can be avoided with the submission of all the correct documents with the MSA.  Some submissions provide an Independent Medical Evaluation or Qualified Medical Evaluator report in lieu of medical records. IMEs, QMEs and similar evaluations may influence a decision, but they cannot replace treatment records. And CMS wants ALL the injury-related records even if workers’ compensation did not pay for the treatment.

When to request a Re-Review

Dan also explains how to handle the Re-Review Appeal process. CMS can make mistakes when issuing counter-highers. He cites several common mistakes, including incorrect prescription drug pricing, misinterpretation of medical records, and using the wrong fee schedule. Always analyze counter-highers for potential errors and consider taking advantage of this appeal.

Tower is here to help manage Medicare Set-Asides

Read the article here and remember that Tower consults with its clients on every aspect of MSA submission and other Medicare Secondary Payer issues. Whether you’re a client yet or not, Dan is available to discuss issues you encounter with your MSAs.  Contact him at