1. RFC ADMINISTRATORS, INC
Hoke S. Wilder Jr.
Margaret D. “Mickey” Wilder

2. RFC ADMINISTRATORS, INC
MEDICARE SET ASIDES (MSA’S)
History– Under Medicare Secondary Payer Law, Medicare Set Asides were established to insure Medicare does not pay for services which could reasonably be expected to be paid through no fault insurance, liability insurance, self insured or workers’ compensation

3. RFC ADMINISTRATORS, INC
WHEN IS AN MSA APPROPRIATE??
- Beneficiary is Medicare eligible
Within 30 months of Medicare eligibility
Total Settlement is greater than $250,000.00

4. RFC ADMINISTRATORS, INC
Review by Centers for Medicare
and Medicaid Services
- Required if settlement is greater than $25,000.00
- Determines whether Medicare’s Interest considered
- Specifically reviews MSA Allocation Report for future medical and prescription drug projections… Are they adequate??
- CMS Response…either agree or change projections
- Serves as a blue print for administration

5. RFC ADMINISTRATORS, INC
MSA ADMINISTRATION
-May be professionally or self administered
-May be funded via Lump Sum or via
an Annuity
- May be administered for life or
for a shorter period of time

6. RFC ADMINISTRATORS, INC
REQUIREMENTS
Must be placed in a FDIC insured, interest
bearing account, separate from all other funds
Funds may only be used to pay for medical or prescription drug requirements which are related to the injury AND would normally be covered by Medicare
The fund may be temporarily or permanently exhausted and if so, Medicare becomes primary payer

7. RFC ADMINISTRATORS, INC
REQUIREMENTS CONTINUED
Payment is made using appropriate fee schedule
State fee schedule- workers’ comp
Physician’s Fee Reference- Personal
injury & liability cases
CMS requires annual accounting of fund
CMS also requires administrator to maintain
Date of Service Diagnosis
Procedure Payment information

8. RFC ADMINISTRATORS, INC
ADMINISTRATOR DUTIES
- Establish the account
Personally contact beneficiary and medical providers
Provide bill review and repricing according to appropriate fee schedule
Insure fiduciary requirements are met
Insure interest rates are maximized and bank charges are minimized

9. RFC ADMINISTRATORS, INC
ADMINISTRATOR DUTIES CONTINUED
Coordinate prescription drug programs according to approved MSA… CPS, our alliance partner plays a vital role.
Maintain documentation and submit reports to CMS as required
Develop and maintain close relationships with financial institutions and alliance partners
Be accessible!!!
beneficiary attorneys providers

10. RFC ADMINISTRATORS, INC
MSA ISSUES
MSA funds may not be adequate
Lack of understanding
Settling party
beneficiary
medical providers
Transitioning from MSA to Medicare and back to MSA
Maintaining communication with all concerned beneficiary, financial institution, medical providers, alliance partners
- Providing personal service.

13. RFC ADMINISTRATORS, INC
QUESTIONS????