Ametros Industry Blog

See the Top Five Reasons Why!

By Porter Leslie, President

The Center for Medicare and Medicaid Services (CMS) recently updated their Reference Guide for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA’s), in Section 17.1 to say:

“It is highly recommended that settlement recipients consider the use of a professional administrator for their funds.”

Medicare went beyond simply mentioning that injured individuals have two ways to administer their MSA's, instead they inserted the phrase that professional administration is "highly recommended." At Ametros, as the clear industry leader in providing professional administration, we take great pride in Medicare’s recommendation, and see it as a vote of confidence in our service and reputation as well as that of the industry we have helped to form.

The government rarely endorses a service, so what compelled them to do so?

We gathered our team’s thoughts and also consulted industry experts to put together a Top 5 list of why Medicare would go out of its way to recommend our service:

1. We save Medicare money

WCMSA administration ensures that the injured party receives discounts on their medical bills. This means they are not paying the full retail price for their medical treatments. Every dollar saved remains in the MSA account and is a dollar that Medicare will not have to spend because the MSA account has not been exhausted. In other words, our savings provide a layer of protection for Medicare so that fewer cases exhaust and Medicare pays less.

We spoke with Geoff Jones, a senior claims attorney at Midwest who added, "Professional administration helps provide a layer of insulation to all stakeholders implicated in the MSA process, including, but not limited to, the claimant, the insured, claimant's counsel, defense counsel and Medicare.”

    2. We support the injured party, while providing them with savings

Tied in with the first point, the money we save is retained by the injured individual in their MSA account. We provide a healthcare advocate so they are not left on their own to deal with the administrative burden. We provide savings not only on prescriptions, but also durable medical equipment, provider visits, and home healthcare. Our savings mean injured individuals, who many times are a vulnerable population, have a professional group helping them preserve their assets. This also addresses one of the most common questions from an injured individual, “What happens if I spend all my settlement funds?” We also are available to make sure they get the treatment they need with their funds. This lowers the likelihood of emergency room visits on Medicare's dime or the injured parties needing to tap Medicaid because their assets are depleted.

As Jones points out, “Moreover, professional administration helps claimants navigate a process that is extremely tedious and I believe the recommendation of Medicare is recognition of that issue."

   3. We provide a realistic and convenient way to comply with Medicare's guidelines

Let's be honest: filing the annual MSA reports, the exhaustion and replenishment reports, and keeping up with Medicare's 140-page reference guide is the task for a professional organization. The average injured party is ill-equipped to gather the data they need and to report properly. Professional administrators like Ametros ensure that the very system Medicare has built is abided by and remains intact.

We also consulted with Stanley Levine, a plaintiff attorney in California who recognized,  “There are times when a professional administrator is really needed in a Medicare set aside.” He added, “A lot depends on the size of the settlement and the capacity of the injured worker.  Ametros is a company that cares about giving good service to my clients."

   4. We collaborate with Medicare to improve the system

At Ametros, we frequently touch base with Medicare to confirm their best practices. We also speak with Medicare's management and contractors to get further clarification to ensure our team and our members understand Medicare’s guidelines.

Our expert team has helped thousands of injured individuals navigate through the intricacies of Medicare's guidelines in order to keep their benefits protected. We do this all while offering substantial discounts for services, and providing a completed annual report for your review and submission to Medicare.

   5. We are a reputable and secure company that safeguards the medical funds of injured parties

Lastly, Medicare must believe that we provide a valuable service that truly benefits all parties involved.  We have forged an industry that does right by the government, the injured party and all the players at the settlement table. It is telling, and a vote of confidence that Medicare is informing the entire industry and every person with an MSA that they recommend professional administration.

According to Levine, “This service is going to be more important to the comp community as time passes. It can certainly help and needs to be looked at by attorneys,” which makes sense that Medicare is directing the industry’s attention to this valuable service.   

Sonja Vigneux, a technical claims specialist in New York, also shared her thoughts on WCMSA administration. "I don’t know why anyone would not want to use a professional administrator for their MSA funds. It takes away the hassle of having to worry about paperwork as well as provides additional costs savings to extend the life of their funds. It’s really a no brainer."

At Ametros, we take Medicare's recommendations seriously and it is our job to turn them into reality.

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