Medicare Set-Aside Professional Administration

Medicare Set-Aside Professional Administration

We have entered an era where The Centers for Medicare and Medicaid Services (CMS) has unprecedented access to settlement data involving Medicare beneficiaries. It is now more important than ever to ensure Medicare’s future interests are protected within your settlements.  Medicare Set-Aside professional administration is a proven tool to assure the settling parties remain in compliance with Medicare Secondary Payer (MSP) obligations.

Medivest is the leading Medicare Set-Aside (MSA) professional administration provider in the industry.  We were the first to professionally administer a Medicare Set-Aside Arrangement, and have been providing this service to the workers’ compensation and liability industry for over 15 years, longer than anyone else. Our services guarantee the most comprehensive and cost-effective professional administration program available. You can be confident that you’re working with the most experienced and trained MSA professionals in the field. The result is unparalleled competency, capability, and service.

We were the first to professionally administer a Medicare Set-Aside Arrangement, and have been providing this service for over 15 years, longer than anyone else in the industry.

Considering Medicare Set-Aside Professional Administration in Your Settlement

There are many situations where medicare set-aside professional administration should be considered, including:

  • Claimant situations that might put the future medical settlement funds at risk, such as mental incompetence, family concerns, etc.
  • Catastrophic injuries where the future medical care is sizable and complex
  • Situations where the primary payer (i.e. carrier, employer, self-insured, etc.) or plaintiff attorney is concerned about a possible post-settlement claim by the injured party for the loss of Medicare benefits due to MSP non-compliance

Unparalleled Fiduciary Expertise

Medivest will navigate the often-complicated waters of MSP compliance for the injured person, so they can focus on addressing their injury. These services go well beyond simply holding funds and paying bills. The injured person will benefit from:

  • Correspondence with Medicare, including the requisite reporting, coordination of primary payer  benefits during periods of temporary or permanent exhaustion, to protect those Medicare benefits
  • Prompt and accurate processing and payment of their medical claims in accordance with MSP compliance rules.
  • Active negotiation with providers on claims in excess of $5,000, to produce greater savings to the account.
  • Prior authorization of new injury-related prescriptions in coordination with their pharmacist
  • Arranging delivery and training on new durable medical equipment, such as beds and wheelchairs
  • Coordination of benefits with the injured person’s other health benefit policies
  • Assistance with arranging disabled access accommodations during travel (for injured persons with professionally administered Medicare non-allowable funds)
  • Coordination with the injured person or their accountant to facilitate annual tax considerations
  • Assisting with the estate planning of account funds at end of life
  • Fiduciary oversight of their medical funds in an interest-bearing account, which is covered by $250,000 in FDIC insurance, as well as SIPC coverage.

Medivest’s professional administration goes well beyond the paying of medical claims. Our experience enables us to offer an array of services others don’t, and that means better care for the injured person.

Medivest utilizes state-of-the-art proprietary software for account management, bill review, and fiduciary accounting. This system is fully developed and continues to be properly maintained by a full-time, in-house software development team.  This unparalleled software produces efficiencies that enable real people to focus on real issues, so that the injured person always receives the personal attention they deserve and require.  Our team is there to help protect, preserve and stretch the funds without sacrificing the quality of the goods or services provided.

The Complex Made Simple for the Injured Person

Medivest makes utilizing the custodial account easy. The injured person simply shows their Medivest Professional Administration Benefit Card, which works exactly like an insurance card, to their doctor or pharmacist. That’s it! No co-pays, no up-front expenses. The medical provider will contact Medivest to verify the account benefits, just as they would with any other major medical insurance provider. The injured party’s billing notices are then sent directly to the Medivest for proper processing.

In addition, Medivest will provide the injured party with access to prescription drug discounts well below CMS’ required Redbook AWP rate. Also, costly durable medical equipment is not a problem. The injured person has access to discounts on items like wheelchairs and beds, and will even receive in-house training on their use when needed.

As Comprehensive as You Need It


Medicare Set-Aside Professional Administration strictly pertains to the management of the Medicare Set-Aside funds only. This service involves adjudication and approval of only Medicare allowable expenses related to the injury. All expenses are paid at the appropriate fee schedule. This is the most comprehensive Medicare Secondary Payer compliance measure available today.


Medical Custodial Professional Administration pertains to the management of a medical custodial account that typically consists of any non-Medicare allowable medical expenses. This service involves adjudication and approval of expenses as dictated by the settlement. MCAs can be used to address a wide variety of issues, from paying only non-Medicare allowable medical expenses, to paying copays on insurance premiums, Medicare copays if the MSA temporarily or permanently exhausts, and even other expenses such as living expenses. Periodic distributions can also be made to the injured person, as dictated by the settlement. The flexibility of the MCA makes it a useful tool that protects settlement funds from dissipation risk, and offers the settling parties assurance that these funds will be used in accordance with the intent of the settlement.

All-In-One (AIO) Professional Administration involves the establishment of two separate accounts, the Medicare Set-Aside (MSA) account, and a Medical Custodial Account (MCA).

This arrangement offers many advantages, including:

  • Strict oversight of all medical settlement funds.
  • Flexible arrangements which can take special circumstances into consideration without jeopardizing MSP compliance.
  • Both the Medicare allowable and non-Medicare allowable portions of the claim can be paid, instead of the injured person being responsible for either portion themselves.
  • Coordination with CMS during MSA exhaustions to pay Medicare copays, resulting in no out-of-pocket medical expenses for the injured person.
  • Deep discounts on annual fees when both accounts are administered by Medivest as a bundle.

Integrating Medivest Medicare Set-Aside Professional Administration Services Into Your Settlement

We’ve helped settling parties engineer win-win solutions in every state in this nation.  From simple straightforward claims, to the most complex, we’ve developed resolutions that address an array of post-settlement concerns.  Medivest’s settlement consultants provide the necessary agreements, settlement language, and guidance to considerably simplify the integration of medicare set-aside professional administration into a settlement.  Services such as file review, mediation consultation, on-site training, and waiver language are provided free of charge, regardless of whether medicare set-aside professional administration is utilized.  We’re committed to facilitating solutions.