Presentation on theme: "RFC ADMINISTRATORS, INC"— 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 eligibleWithin 30 months of Medicare eligibilityTotal Settlement is greater than $250,000.00
4 RFC ADMINISTRATORS, INC Review by Centers for Medicareand 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 viaan Annuity- May be administered for life orfor a shorter period of time
6 RFC ADMINISTRATORS, INC REQUIREMENTSMust be placed in a FDIC insured, interestbearing account, separate from all other fundsFunds may only be used to pay for medical or prescription drug requirements which are related to the injury AND would normally be covered by MedicareThe fund may be temporarily or permanently exhausted and if so, Medicare becomes primary payer
7 RFC ADMINISTRATORS, INC REQUIREMENTS CONTINUEDPayment is made using appropriate fee scheduleState fee schedule- workers’ compPhysician’s Fee Reference- Personalinjury & liability casesCMS requires annual accounting of fundCMS also requires administrator to maintainDate of Service DiagnosisProcedure Payment information
8 RFC ADMINISTRATORS, INC ADMINISTRATOR DUTIES- Establish the accountPersonally contact beneficiary and medical providersProvide bill review and repricing according to appropriate fee scheduleInsure fiduciary requirements are metInsure interest rates are maximized and bank charges are minimized
9 RFC ADMINISTRATORS, INC ADMINISTRATOR DUTIES CONTINUEDCoordinate prescription drug programs according to approved MSA… CPS, our alliance partner plays a vital role.Maintain documentation and submit reports to CMS as requiredDevelop and maintain close relationships with financial institutions and alliance partnersBe accessible!!!beneficiary attorneys providers
10 RFC ADMINISTRATORS, INC MSA ISSUESMSA funds may not be adequateLack of understandingSettling partybeneficiarymedical providersTransitioning from MSA to Medicare and back to MSAMaintaining communication with all concerned beneficiary, financial institution, medical providers, alliance partners- Providing personal service.
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