Workers’ Compensation Medicare Set-Aside

Fidelity Fiduciary Company, LLC is a professional administrator of funding agreements where the funding will not be levied and includes:

  • Settled Workers’ Compensation cases with structured or lump sum funding
  • Medicare Set-Asides submitted and approved by Medicare
  • WCMSA Custodial Agreements signed by all parties
  • Annual banking statements provided to accounts showing interest earned, deposits and expenditures
  • Annual 1099-Int forms provided to accounts for tax purposes/filing
  • Annual Attestation (financial expenditure) reports provided to Medicare (CMS)
  • Professional case management assistance
  • Utilization Review claim decisions for determinations of being both injury-related and Medicare-covered
  • WC Fee Schedule adjustments
  • Medical and Pharmacy wallet-size “insurance” cards to assist with billing
  • Claims Payment Services
  • Bill Reviews (EOR/EOB) sent to providers along with payment
  • Pharmacy Benefit Management for Rx cost containment management

We act as an objective third party responsible for medical and pharmacy cash disbursements to the appropriate providers.  It is our goal to make sure each interest-bearing account is managed honestly and ethically, as well as per legal and IRS guidelines. Also, our team of associates have considerable experience in Workers’ Compensation, medical aspects of disability, nurse utilization review, pharmacy management, and business administration. Thus, you will be dealing with “hands-on” highly trained and industry-specific PROFESSIONALS, not simply a help desk clerk as our competitors may employ.

How does the process work?

FFC manages all aspects and steps in the process of utilization and administration of the account.  When we receive a referral, we work in conjunction with all involved parties to draft a WCMSA Custodial Agreement appropriate for the particular type of claim parameters.  After the agreement is signed by all parties indicating responsibilities and liabilities, and the account is opened, FFC notifies all existing medical providers by fax or letter of our role in the handling of these accounts. Medicare beneficiaries (now called FFC “Accounts”) then receive medical insurance cards and pharmacy cards to show providers, thereby acting as a guide throughout the entire process, from prior-authorization to post-treatment billing. Medical claims received post-treatment are then processed through our utilization review department for determinations of being injury-related and Medicare-covered. From there, the bills pass through our Bill Review department for the appropriate fee schedule reductions. On the pharmacy side, our nurses communicate with pharmacists to approve or deny prescriptions presented by our accounts and then our cost-containment prescription re-pricing is conducted thereby insuring sustainability of the set-aside funds.

What are the benefits for WC carriers/self-insureds referring settled cases to FFC?

  1. Claims administration savings
  2. Recapture of indemnity claims dollars upon termination of claim
  3. A tool to meet Medicare requirements and guidelines

What are the benefits to claimants who settle their future medical using a professional administrator?

  1. They are relieved of all Medicare requirements for administering MSA funds and reporting to Medicare
  2. They do not have to deal with admissions, billing or insurance departments with hospitals or medical providers
  3. They do not have to pay or write checks to providers
  4. They do not have to deal with ICD-10 diagnosis codes, medical terminology, medical supplies or medical procedures related to prior-authorizations/pre-certifications
  5. They do not have to worry about losing Medicare coverage on future medical treatment
  6. They do not have to deal with letters from Medicare or Medicare Advantage Plans regarding recovery (repayment)
  7. They have professional assistance when needing to find a new physician, psychiatrist, therapist, etc.
  8. They have professional assistance to help them navigate the complexities of today’s healthcare market

Pricing

Set-Up Fee (one-time only): $1000
Annual Administration Fee: $0 (If Seed Deposit is greater than $50,000) OR $500 (If Seed Deposit is less than $50,000)