White Paper

Taming the Wild, Wild West of Medicare Set-Asides

Since the inception of the Medicare program and Medicare Secondary Payer Act, the world of Medicare Set-Asides has been like the Wild West. We’re here to help you tame it.

White Paper Summary

Since the inception of the Medicare program in 1965 and the Medicare Secondary Payer (MSP) Act being established in 1980, the world of Medicare Set-Asides (MSAs) has been like the Wild, Wild West. Why? The regulatory guidelines are relatively open to interpretation with a lack of enforceability.

Medicare Set-Aside (MSA) services were born from Medicare’s “secondary” status, which gives the federal government a right of recovery against primary payers. Unfortunately, Medicare’s right of recovery does not come with clear, objective guidelines and an enforceable rationale. This vacuum of “law and order” creates an overly complicated MSA process that is subject to continual change.

As a result, payers – including employers and insurance carriers – need a comprehensive suite of programs designed to fully comply with the requirements of the MSP Act. MSA solutions partners like EK Health Services, Inc., provide the highest quality evaluations and reports to expedite claim resolution and accurately forecast settlement costs. In doing so, we help payers avoid the pitfalls and financial burden of inflated settlement costs that accompany high set-aside allocations.

MSAs are by nature a risky and ever-changing landscape – much like the Wild West – and it is critically important to engage expert resources to secure safe passage through to the optimal outcomes you need. EK Health in particular has tamed the Wild, Wild West of MSAs by leveraging its clinical expertise. Our evidence-based MSA process focuses on Evidence-Based Medical guidelines to deliver highly defensible MSA results.


To learn more about EK Health’s MSA solutions and to see how your workers’ compensation program can benefit, visit ekhealth.com or email the author at [email protected].

 

As a leading national managed care company, EK Health Services, Inc. sets the gold standard for medical case management, utilization review, medical bill review, network management, and Medicare Set-Asides. We facilitate quality, cost-efficient medical treatment for workers' compensation claims.

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