Save Money & Stay Compliant

An MSA should be considered whenever a Workers' Compensation or liability claim involves a Medicare beneficiary or someone with a reasonable expectation of Medicare enrollment within 30 months. CMS review thresholds and best practices guide when formal submission is appropriate.

The waiting period refers to the time between when an MSA is submitted to CMS for review and when CMS issues its determination. During this period, settlement cannot be finalized pending CMS approval or suggested modifications to the MSA amount.

CMS voluntary review is appropriate when the claimant is a current Medicare beneficiary and the total settlement exceeds $25,000, or when the claimant has a reasonable expectation of Medicare enrollment within 30 months and the total settlement exceeds $250,000.

Once MSA funds are properly exhausted through appropriate medical expenses, Medicare becomes the primary payer for injury-related treatment. Proper documentation of MSA fund expenditure is critical to demonstrate compliance and ensure Medicare coverage continues.

A Medical Cost Projection is appropriate when a claim does not meet CMS review thresholds but parties still want to demonstrate good faith consideration of Medicare's interests, or when a lower-cost alternative to a full MSA is needed to facilitate settlement.