San Jose, CA -(BusinessWire)- EK Health Services, Inc. recently announced that it has expanded staff and resources for its Medicare Set-Aside (MSA) services to meet needs of workers’ compensation payers to effectively comply with new guidelines from Center for Medicare and Medicaid Services (CMS).
Issued March 29, the CMS guidelines represent the first comprehensive instructions for Workers’ Compensation Medicare Set-Aside Arrangements (WCMSA), a process payers must follow to protect Medicare’s financial interest when settling work injury claims. Prior communications from CMS were delivered through a series of memos with ambiguous and confusing language.
The guidelines represent a major shift in CMS’ approach to defining MSA policies and procedures. Specifically, they state clearly that Medicare’s interest must be protected regardless of whether the claim meets CMS’ thresholds for submission of an MSA.
“Any claim where Medicare eligibility could be a factor is impacted by the guidelines,” said Jake Reason, EK Health’s Vice President of Medicare Set-Aside Services. “The agency is now explicit that settlements of any kind in work injury cases are fair game for CMS scrutiny, making it clear that payers are accountable for managing their Medicare compliance effectively.”
As a leading national workers’ compensation managed care company, EK Health already provides MSA services for existing clients. By acquiring additional staff experienced in MSA, backed by EK Health’s clinical expertise, EK Health is armed with the best resources to meet the demand for these specialized services.
“Our role is to assist payers achieve settlement without over-funding set-asides needlessly,” said Reason, adding that EK Health has earned a reputation for helping payers avoid the pitfalls of paying inflated settlement costs that often accompany high set-aside allocations.
Anita Breedlove, Executive Vice President of Business Development for EK Health, said the expansion aligns with EK Health’s overall growth strategy. “We are committed to growing our national footprint, and we are accomplishing this by bringing the best talent and innovation to every aspect of claims management throughout the broader workers’ compensation community,” she said.