Is the injured party entitled to a release of the Medicare Set-aside funds if the injured party loses Medicare entitlement?
A57. No. However, the funds in the Medicare Set-aside may be expended for medical expenses or prescription drug charges specified in the Medicare Set-aside until Medicare entitlement is re-established or the Medicare Set-aside is properly exhausted. Use of the Medicare Set-aside is limited to medical services and prescription drug charges that are due to the work or accident that would otherwise be covered by Medicare if the injured worker were a Medicare beneficiary. CMS will not pay for any expenses related to the workers’ compensation claim or settlement until a self-attestation document or a full accounting of all monies expended from the Medicare Set-aside are sent to the lead contractor upon the re-establishment of Medicare entitlement. At that time, the lead contractor will adjust the Medicare Set-aside record to reflect the expenses paid prior to entitlement. Comment: If, in fact, the injured party’s Medicare entitlement is lost, and there is no reasonable likelihood that it wi
A57. No. However, the funds in the Medicare Set-aside may be expended for medical expenses or prescription drug charges specified in the Medicare Set-aside until Medicare entitlement is re-established or the Medicare Set-aside is properly exhausted. Use of the Medicare Set-aside is limited to medical services and prescription drug charges that are due to the work or accident that would otherwise be covered by Medicare if the injured party were a Medicare beneficiary. CMS will not pay for any expenses related to the workers’ compensation claim or settlement until a self-attestation document or a full accounting of all monies expended from the Medicare Set-aside are sent to the lead contractor upon the re-establishment of Medicare entitlement. At that time, the lead contractor will adjust the Medicare Set-aside record to reflect the expenses paid prior to entitlement. Comment: If, in fact, the injured party=s Medicare entitlement is lost, and there is no reasonable likelihood that it wil
Related Questions
- Does Medicare give written advance advisory opinions on the sufficiency of a Medicare Set-aside even if the injured party is not as yet entitled to Medicare?
- Does Medicare give written advisory opinions on the sufficiency of a Medicare Set-aside even if the injured party is not as yet entitled to Medicare?
- Is the injured party entitled to a release of the Medicare Set-aside funds if the injured party loses Medicare entitlement?
