Medicare Set Aside Accounts

Providing Administrative Services for

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How Ametros works with Medicare Set Aside Accounts

When an injured party settles the medical portion of their claim and they are eligible for Medicare or soon to be eligible, a Medicare Set Aside Account (MSA) can be established. The Centers for Medicare and Medicaid Services (CMS) have a number of specific reporting requirements for these types of medical settlements.  In summary, CMS requires that all Medicare Set Asides be administered following these main six guidelines:

• Deposit the fund into an interest-bearing account

• Use the fund only for treatments related to the injury

• Use the fund only for Medicare covered expenses

• Pay according to the appropriate fee schedule

• Prepare and submit annual accounting report to CMS

• Maintain line item detail for the duration of eligibility

If the claimant/plaintiff does not comply with this complex list of requirements, they risk being denied their benefits by Medicare. Ametros is the industry leader in managing MSA funds, providing self administration tools as well as full professional administration.

Professional Administration - CareGuard

This service helps parties with an MSA account remain compliant with the Medicare Secondary Payer Act. Services include capturing all bills, processing payments and reporting regularly to the member and CMS in full compliance with Medicare regulations. When a case settles with an MSA, the injured party has a responsibility to report their purchases annually to Medicare, in order to protect their Medicare benefits. CareGuard handles all annual reporting and also guides members through what purchases can and cannot be made out of the account.

Once on the CareGuard platform, members will have access to the benefits of CareGuard including:

• Extending the Life of the MSA Fund: On average members save 62% on provider bills, and 28% of the projected value of their MSA on expenses such as durable medical equipment, medical treatment, and prescriptions.

• Freedom to Treat: Members can see any doctor or provider, without Utilization Review.

• Support: 24/7 access to our team of Care Advocates.

• Technology: A state-of-the-art online portal where members can review the status and total savings of their CareGuard MSA Account.

• Reporting: 100% Medicare compliance.

Self Administration - Amethyst

When self administering an MSA, the injured party is responsible for producing all of the annual reporting that Medicare requires. Historically, little to no savings were made available to individuals self administering their MSA. With Amethyst, members have access to a vast network of savings and 24/7 access to our Care Advocate team. Additionally, Amethyst provides them with the tools needed to compile their annual report to Medicare listing all their expenses. All the while, the funds remain in their personal bank account.

Once on the Amethyst platform, members will have access to the benefits of Amethyst including:

• Savings: An average annual savings of 21% on their projected MSA value.

• Technology: A state-of-the-art online portal where members can chat, view spending trends and savings amounts.

• Freedom to Treat: Members can see any doctor or provider, without Utilization Review.

• Support: 24/7 access to our team of Care Advocates.

• Reporting: Medicare compliance support.