An MSA is a financial agreement that allocates a portion of a claimant’s settlement to pay for injury related future medical services.  These funds must be depleted before Medicare will pay for treatment related to the claim as a secondary payer.

All parties in a workers’ compensation case have significant responsibilities under the Medicare Secondary Payer (MSP) laws to protect Medicare’s interests when resolving cases that include future medical expenses.  The recommended method to protect Medicare’s interests is an MSA. 

There are no statutory or regulatory provisions requiring that an MSA proposal be submitted to the Centers for Medicare and Medicaid Services (CMS) for review as submission of a is a voluntary process. Currently, for workers’ compensation claims, the CMS review thresholds are when the settlement is over $25,000.00 and the claimant is a Medicare beneficiary or, if the claimant has reasonable expectation in becoming a recipient within 30 months of the date of settlement AND the settlement is of $250,000.00.  Currently there is no formal review process for liability MSA’s, and CMS has not supplied much information surrounding this topic.  Therefore, the focus of the Medicare Set-Aside Certified Planner (MSACP) program is workers’ compensation MSAs.

MSACP is a certification for completion of eleven courses on the history, principles, and development of a workers’ compensation MSA. The certification was developed by Sanderson Firm and WorkCompCollege, and includes instruction from many well-known MSP and claims professionals throughout the industry. MSACP Covers topics surrounding, the importance of records and prescription history reviews, steps to complete an MSA, CMS submissions, Non-Submit and Evidence-Based MSA’s, and mitigation strategies.

MSACP targets professionals in MSP compliance, workers’ compensation, and legal fields, and even those simply interested in learning more about MSA’s. MSACP makes understanding MSA’s approachable, meaning even those without any prior experience will benefit from completing the MSACP course.

For licensed lawyers and/or nurses, you may be eligible to receive continuing education credits for successfully completing the MSACP course. For licensed lawyers, any request for CLEs must be made by you to your state bar association, and your state bar association reserves the right to decline to grant CLE credits. Similarly, for licensed nurses, any request for CEs must be made by you to your state board, and your state board reserves the right to decline to grant CE credits. When submitting such requests to your state bar association and/or state board, we recommend providing a copy of your MSACP Certificate of Completion; documentation requirements may vary.

MSACP is the most modern and flexible certification currently available in the MSP space. Students of MSACP may take the course anywhere, anytime on any device at his/her own pace. This alleviates unnecessary time off and time away from work and thus significantly benefits the student as well as his/her employer. As part of this program, the student will NOT have to create an MSA in order to pass.

The MSACP curriculum is updated regularly. Students of MSACP will be able to network and receive updates from MSP College faculty regularly.

Students are not required to complete an MSA to obtain an MSACP certification. The MSACP faculty do an excellent job of breaking down the components of an MSA in detail. You will learn how to complete an MSA from the time of referral all the way up to the time of CMS submission. We thoroughly go over:

• Medical records and payment history review

• Extracting information from the medical records and crafting a medical summary

• Allocating and pricing future medical care, including prescription medications (evidence based and traditional allocations)

• Denied and non-covered treatments

• Medical mitigation strategies

• CMS submissions

• Professional administration options

 Additionally, the final exam has specific scenarios and questions tailored to allocating an MSA.  These questions provide the same experience to test student’s knowledge as completing an MSA without the added step and time.