Our Services
WCMSA Post-Settlement Advisory Services
For Individuals who are Self-Administering their WCMSA Funds Post-Settlement
Attorneys, carriers or the injured workers/Medicare beneficiaries themselves can consult us by phone, letter or email if you think Medicare compliance of WCMSA funds is at RISK post-settlement. After three (3) years of contracted Custodial Assistance services, the injured worker should be able to successfully Self Administer the WCMSA funds, remain Medicare eligible and remain MSA compliant.
Settlement Threshold
We will handle settlements of ANY dollar amounts (no minimums or maximums)
Referral Timeline
Referrals come to FFC after the settlement has been court-approved
Pricing
Pricing is typically determined on a case by case basis. Please call or fill out the contact form for a specific quote by case facts.
Services Provided the First 3 Years
FFC will provide a Welcome and Orientation letter to the Injured Worker as soon as the file is officially opened.
FFC will provide telephone, mail and email services from our professional and administrative staff as needed.
FFC will provide Medicare’s Self-Administration Toolkit and personally guide Injured Workers in how to use it.
The program will operate under a signed Custodial Agreement outlining the responsibilities of the parties.
Non-Submission Workers’ Compensation Medicare Set-Asides
This program offers full professional custodial services for WCMSA claims not submitted or approved by Medicare. Utilizing our Medical and Pharmacy Benefit Management resources, we make medical and pharmacy payments below the WC Fee Schedules.
What’s Required?
The Medicare Set-Aside funds
The Approved Settlement Documents
The MSA (Allocation/Medical Cost Projection) report
Services Include:
❊ WCMSA Custodial Agreements signed by all parties
❊ Annual financial statements provided to accounts showing interest earned, deposits and expenditures
❊ Annual 1099-Interest forms provided to accounts for tax purposes/filing
❊ Professional case management assistance
❊ Utilization Review claim decisions as 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 cost containment and account sustainability
Structured Settlement & Lump Sum Pricing Set-Up Fee
Pricing is typically determined on a case by case basis. Please call or fill out the contact form for a specific quote by case facts.
Liability Medicare Set-Asides
When Is a Liability Medicare Set-Aside Needed?
If someone is injured in a non-work-related incident, like a car accident or a fall in a store, they may pursue a third-party liability claim. If the claim results in a settlement and the person is a Medicare beneficiary, a Liability Medicare Set-Aside (LMSA) may be needed to protect their future Medicare eligibility. An LMSA allocates a portion of the settlement specifically for future medical costs related to the injury. While anticipated, formal guidelines for LMSAs have yet to be established.
Protecting Medicare’s Interests
While CMS hasn’t issued formal guidelines for Liability Medicare Set-Asides (LMSAs), they’ve made one thing clear: Medicare’s interests must be protected in all settlements, not just workers’ compensation cases. Unless a treating physician provides written confirmation that treatment is complete, an LMSA should be considered. At FFC, we believe establishing and administering an LMSA is the best way to ensure compliance. Let us help, contact us to learn more.
WCSMA Self-Administration Assistance Program
A single hospital stay or new medication can quickly drain your WCMSA funds, making Medicare the primary payer and leaving you to cover non-covered costs. Many providers aren’t Medicare-approved, adding to the challenge. If you're self-administering, navigating this system alone can be overwhelming. Expert help makes all the difference.
Why you need a “SAAP” for your “Workers’ Compensation Medicare Set-Aside”
Remain Medicare eligible
Extend the life of your WCMSA funds
Avoid paying out-of-pocket for Medicare co-payments, deductibles and coinsurance
Here is what FFC can do for you:
Administer all your WC related medical needs providing you deep discounts on RX and medical supply prices.
Administer just your RX program providing you with cost-saving measures from our bill reduction partners.
Enroll in FFC’s Bill Pay Program to keep your settlement funds while we help pay your discounted medical bills. For a small fee, we’ll send you Medicare’s Self-Administration Kit and provide one year of support to help you stay Medicare-compliant and build a strong, credible relationship with Medicare from the start.
An advanced no-cost option lets you keep your medical settlement funds while directing pharmacy/DME funds to FFC for investment in an interest-bearing account, enrolling you in our pharmacy/DME program. Alternatively, FFC can set up an ACH account (with form) to pay WC-related medical bills for a $500 annual fee. Both options ensure only Medicare-covered, WC injury-related bills below retail pricing are processed and paid.
Provide you with an Annual Financial Statement itemizing our payments and your savings throughout the year. You will need this figure to complete the Attestation form you must send to Medicare annually. It is also excellent documentation should Medicare ever question your expenditures.
WCMSA “Modified” Administration Program
Why purchase a “MAP” for a “Workers’ Compensation Medicare Set-Aside” (WCMSA)?
Our MAP program helps injured workers stay in discounted pharmacy and DME networks, extending the life of their WCMSA funds and preserving Medicare eligibility. Without it, one unexpected medical expense can drain the account, making Medicare the primary payer and leaving the beneficiary to cover out-of-pocket costs. Self-administration means managing paperwork and finding discounts alone. With FFC, you don’t have to.
What Fidelity Fiduciary Company (FFC) can do for the injured worker at low cost to the payer:
FFC provides beneficiaries with Medicare’s Self-Administration Kit and one year of support to help them understand their responsibilities and build a strong foundation for ongoing Medicare compliance.
Pharmacy and DME settlement funds are held in an interest-bearing account and used only for Medicare-approved, injury-related expenses at discounted rates through our savings program. This helps preserve WCMSA funds and reduce out-of-pocket costs.
Each year, we provide an Annual Financial Statement to assist with Medicare’s required attestation and ensure accurate documentation if questions ever arise.
Benefit Review
Report Services
Don’t let options confuse you.
Let FFC help you sort it out.
Whether you need additional information for settlements, old-dog cases, or active cases you are struggling with, let FFC help you! As we all know, there is an abundance of benefit packages related to injured workers, Medicare beneficiaries, and their family members. Understanding how to preserve these benefits pre-and-post-settlement is key to positive outcomes for everyone.
Here are a few of the more common benefit programs:
❊ Medicare (Parts, A, B, or D)
❊ Medicaid
❊ Social Security Disability Income (SSDI)
❊ Supplemental Security Income (SSI)
❊ Veterans Healthcare
❊ Veterans Compensation & Disability
❊ Supplemental Nutrition Assistance Program (SNAP)/EBT/Food Stamps
❊ Medicare Set-Aside (MSA)
❊ Medigap
❊ Medicare Advantage (also known as Medicare Part C)
❊ Consolidated Omnibus Budget Reconciliation Act (COBRA)
❊ Institutional Care Program (Long Term Nursing Home Care)
❊ Medically Needy Program
❊ MEDS-AD
❊ Protected Medicaid
❊ Home or Community Based Medicaid Waiver Programs
❊ Optional State Supplementation
❊ Home Care for Elderly and disabled (HCE/DA)
❊ MRMIP (CA Only)
What an FFC “Benefit Report” will include:
Explanation of Benefits
Benefits entitled to, also benefits denied
How your benefits interact, who pays first and when in your specific state
Special circumstances
Calculations for benefits offset (i.e. SSDI and Lump Sum)
Best Practices for beneficiaries with settlements or about to settle
How to preserve your benefits
What will impair your benefits if you settle without proper planning
Common mistakes
Basic Budgeting for your post settlement needs
How much you need based on current benefits and needs
Recurring costs and one off large items (i.e. home or car)
Other Helpful Information
Dealing with a Special Needs Trust?
Purchasing Trust Administration?
CMS Self-Administration Toolkit
Toolkit for Workers’ Compensation Medicare Set-Aside Arrangements
For WCMSAs Approved by the Centers for Medicare & Medicaid Services (CMS)
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Download
Click the link below to download the toolkit.
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