To resolve workers' compensation or liability cases involving compensation for future medical expenses, one must determine if the Medicare Secondary Payer Act (USC §1395y(b)) (the "MSP") applies. If yes, one must act to protect Medicare's future interest. That's where a Medicare set aside (MSA) can be of use. And if an MSA has been performed, the last thing an injured claimant needs to worry about is concerns over the administration of the MSA. That's why Providio’s MSA CareGuard, powered by Ametros Financial, offers a simple solution that safeguards Medicare benefits and delivers comprehensive, professional MSA administration at an affordable price.

Sometimes, the answers aren't clear but the stakes are high. That's when you want to take the safest and most-conservative approach. Even though MSAs are not currently required, the Centers for Medicare and Medicaid Services (CMS) have noted that an MSA is strongly preferred in some cases. The free case consultation service offered by Providio is an excellent way to learn if the MSP applies to your case and whether an MSA is recommended. Not only are our MSA consultants some of the foremost experts in the industry, our process guarantees that all MSAs have a three-business-day standard turnaround — with no rush fees!

Workers' Compensation MSAs (WCMSA)

CMS has provided detailed guidance regarding why and how MSAs are preferred to protect Medicare’s future interest in workers' compensation cases. They have also created a voluntary MSA submission process that confers safe-harbor protection on all WCMSAs they review and approve. In workers’ compensation cases, the experts at Providio offer the following services:

Liability MSAs (LMSA)

Though CMS has not provided clear guidance regarding specific compliance processes and tools in liability cases, parties must still obey the MSP. Providio knows MSAs are the most-conservative option, even though they clearly are not required. Liability MSAs (LMSA) confer protection and are appropriate in cases where claimants have catastrophic injuries that require future care Medicare would otherwise cover. Even so, other options may be more appropriate given the facts of a specific case. At Providio, our experts pioneered the apportioning of an LMSA to account for such issues as damage caps, policy limits, made-whole issues and common-fund defenses. In liability cases, we offer the following services:

Professional Administration of MSAs

An injured claimant has enough to worry about without concerns over the proper administration of an MSA. That's why Providio's MSA CareGuard, powered by Ametros Financial, is a simple, all-in-one solution that safeguards Medicare benefits and delivers comprehensive, professional MSA administration at an affordable price.

Professional administration simplifies matters for the claimant. The experts at Providio MSA CareGuard ensure bills are captured, paid, and reported to both the member and CMS in compliance with Medicare regulations. Rather than a pool, we manage all MSA funds out of a competitive, growth account in the member’s name. With our Pharmacy Benefit Manager, Providio MSA CareGuard extends the life of the MSA and allows members to receive medications, equipment, or services at prices they couldn't obtain otherwise. This increases the odds that members will have funds in the account to pass to beneficiaries.

How does Providio MSA CareGuard Work?

For members, Providio MSA CareGuard works like traditional health insurance. When in need of MSA related treatment, prescriptions, or services; the member presents a card to their healthcare provider or pharmacist–who submits eligibility requests as they would for any other healthcare plan. In turn, the member receives authorized prescriptions and medical services.

Greg Barnhart, Esq. | Partner, Searcy Denney Scarola Barnhart & Shipley Our practice is dynamic and we settle many cases where the client is both Medicare eligible and receiving compensation for future medicals. We like to approach Medicare Secondary Payer Act compliance from a conservative perspective to ensure we are doing all we can to protect our clients and their Medicare benefits. While we know Medicare Set Asides aren't required and we don't use them in every situation, when we do there is no one we trust more than Providio. They are easy to work with and with their 3-day guaranteed turn around they are able to help us move toward disbursement of funds quickly. Providio's ability to apportion MSAs for a reduced final amount is really valuable and so important to helping reach the most fair result for the injured party. Across the board we appreciate Providio's team and we're happy to have them as a partner in our post-settlement process.
Stephen Johnson, Esq. | Partner, Stephen Johnson Law I am a sole practitioner and handle both liability and workers' compensation cases. As a result, I have encountered Medicare Secondary Payer issues from both the workers' compensation and liability aspects. I have used Providio to provide MSA services exclusively since 2009. With regard to WCMSAs, there are times when I have not had the ability to choose Providio because compensation carriers sometimes desire to select their own service provider. This has afforded me the benefit of comparing the services of some other, and often well-known providers, to the services of Providio. In my experience, Providio has provided its services more efficiently, accurately and thoroughly than other providers I have encountered. With regard to the liability cases I handle, the professionals at Providio have provided thoughtful guidance and suggestions to ensure I am protecting my clients' future eligibility for Medicare. Providio's professionals are knowledgeable, approachable and are always eager to discuss the specific details of each case before offering advice. Because CMS has offered no guidance on liability cases, and because each liability case presents its own facts, circumstances and legal issues, Providio's liability MSA services have been invaluable to me to ensure both my clients and I are taking reasonable steps to comply with the Secondary Payer provisions. Since 2009 I have recommended others in my legal community to use Providio on liability and compensation cases, I will continue to do so in the future.