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

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Presentation on theme: "RFC ADMINISTRATORS, INC Hoke S. Wilder Jr. Margaret D. “Mickey” Wilder."— Presentation transcript:

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, 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 ServiceDiagnosis ProcedurePayment 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.




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