5 Questions with Brendon De Souza on MSAs, CLM Session

Conference Preview

At next month's CLM Work Comp Conference, Sanderson Firm's Brendon De Souza will be on a panel presenting "Beyond Thresholds: CMS’s 2025 Medicare Set-Aside Reporting Requirements." We were fortunate to borrow some of Mr. De Souza's time for a few questions about Medicare Set Asides and the CLM session.

Q: Why is this topic important? 

Brendon De Souza: Many workers’ compensation claims professionals are unaware of the new level of insight that the federal government has into workers’ compensation settlements involving Medicare beneficiaries. For the first time ever, the Centers for Medicare & Medicaid Services (CMS) will know about the existence (and funding details) of Medicare Set-Asides, even if a Medicare-Set Aside was not funded as part of a settlement and even if a Medicare Set-Aside was not formally submitted to CMS for formal review and approval. As a result, workers’ compensation claims professionals must remain diligent in preparing Medicare Set-Asides to prevent denial of Medicare benefit issues post-settlement.

Q: Who should attend this session? 

BD: Claims adjusters/handlers, claimant attorneys, defense attorneys, employers, carrier, and all other claims professionals involved in workers’ compensation settlements.

Q: What can attendees expect to learn from this session? 

BD: Attendees will learn of the recent workers’ compensation Medicare Set-Aside reporting requirement as well as have common “myths” dispelled regarding non-submission of Medicare Set-Asides and when Medicare Set-Asides should / should not be prepared.

Q: How would you describe the current state of MSA reporting requirements in terms of what past history has been? 

BD: Medicare Set-Aside reporting is brand new, and it has been challenging for many self-insureds and insurance carriers to adapt to.

Q: What's the biggest challenge in MSA reporting right now? 

BD: The biggest challenges for self-insureds and insurance carriers are (1) change in overall approach to Medicare Set-Aside triggers (no longer decline to prepare a Medicare Set-Aside if the settlement will not exceed $25,000), and (2) technical issues (e.g., inability to report Medicare Set-Aside values through claims systems properly).

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