Medicare Set-Aside | GENEX Services

Medicare Set-Aside

Worker's Compensation carriers are under increasing pressure to consider and protect the interests of Medicare when settling claims. In fact, under federal law, any entity found to be shifting the burden to Medicare to pay for future medical costs related to an injured individual's workers' compensation/liability/automobile injury, accident, or illness can be held liable for double damages, penalties, and fines. In order to protect Medicare interests, an appropriate amount of settlement money should be "set-aside" for the payment of future medical costs that might otherwise be paid by Medicare.

To assist carriers in meeting these obligations, the GENEX Medicare Set-Aside (MSA) program offers:

      • Reporting Agent Services - CMS registration implementation, beneficiary and settlement reporting
      • Medicare Verification - beneficiary and non-beneficiary
      • MSA Cost Projections
      • MSA Submissions
      • Conditional Payment Search, Analysis, and Disputes

To contact our MSA experts, please click here.

Life Care Planning

Life Care Planning allows adjusters and attorneys working with disabled individuals to plan for the future with the knowledge of when and how the expenditures for care will be allocated, allowing for financial planning and the setting of reserves from provider sources. Life Care Plans also provide an excellent tool for claim settlement negotiations.

Highly qualified GENEX professionals with more than 25 years of experience in Life Care Planning are able to accurately establish and quantify medical damages resulting from an injury. We provide a detailed outline of the current and future medical, vocational, educational, and psychosocial needs of a catastrophically ill or injured individual, while projecting the related costs annually or over the individual's life expectancy.