Medicare Set Aside Allocation

Medicare Set-Aside is the allocation from a settlement of a Workers Compensation or Social Security Disability case. It is established from a portion of the settlement amount to be used to pay future medical expenses related to the injury or disability that would otherwise be payable by Medicare. Making sure Medicare Set-Aside allocations are accurate and meet the proper standards is a complex challenge and a vital component of many claims.

All parties in a Workers Compensation or Social Security Disability case have significant responsibilities under the Medicare Secondary Payer laws to protect Medicare’s interests when resolving cases that include future medical expenses. To assist in meeting the criteria set forth by Centers for Medicare and Medicaid Services, VP Medical Consulting’s skilled staff within our Medicare Set-Aside Program is able to determine the appropriate amount to be “set aside” based on an expert analysis of the condition, current treatment, projected future treatment and life expectancy of the individual. Once that amount is exhausted and accurately accounted for by Centers for Medicare and Medicaid Services, Medicare will begin paying the primary for future Medicare covered expenses related to the Workers Compensation Injury or Social Security Disability.

• Medicare Set-Aside Services include:
• Claimant education
• Thorough review of records
• Determination as to qualified individual under Medicare guidelines
• Comprehensive Financial Analysis
• Lien investigation and negotiations
• Medicare Set-Aside projection allocation
• Legal Review written by credentialed Registered Nurse
• Medicare Set-Aside prepared in accordance with Centers for Medicare and Medicaid Services guidelines
• Centers for Medicare and Medicaid Services submission

If you or someone you know is in need of assistance with a Medicare Set Aside case, please use our Medicare Set Aside Referral Form to let us know about it.