Medicare Professional Administration

Name: Medicare Professional Administration
Brand: Physician Life Care Planning
Rating: 4.4 (19 reviews)

After a case closes, someone still has to manage the funds, file the reports, and keep Medicare satisfied. Physician Life Care Planning handles all of it, so injured parties get care, and attorneys stay protected.

What Is Professional MSA Administration?

When future medical costs are reserved through a Medicare Set-Aside arrangement, those funds don't manage themselves. Every dollar spent must be documented, reported to Medicare annually, and used only for Medicare-covered injury-related expenses. One misstep can trigger compliance consequences that outlast the case by years. Professional administration places a qualified third-party custodian in charge of that entire process. Administering Medicare Set-aside funds requires the competence to decipher whether a provider’s bill is for injury-related and Medicare-covered medical costs, at what price those services should be paid (or could be paid if negotiated well), accurate record keeping, and the ability to calculate tax obligations on accrued interest, and the savvy to provide attestations to CMS.

While Medicare stops short of requiring it, CMS highly recommends professional administration to be considered in any case, and especially when certain types of medications have been prescribed. In an era where the agency has unprecedented visibility into beneficiary data and recovery activity, that recommendation carries real weight. Physician Life Care Planning takes on the full administrative burden: establishing the account, verifying benefits with providers, processing billing, and handling all required Medicare reporting.

How It Works for the Injured Person

No co-pays. No deductibles. No out-of-pocket costs for covered injury-related care. The experience for the account holder is designed to be simple:

Step 1: At the doctor's or pharmacy, the injured person presents their Physician Life Care Planning Member ID Card, just as they would with any insurance card.
Step 2: The provider contacts us to verify benefits and confirm coverage for the planned treatment or prescription.
Step 3: Billing goes directly to us. Physician Life Care Planning adjudicates the claim, confirms it qualifies under the arrangement, and processes payment at the appropriate fee schedule, or may make an offer and subsequently resolve the bill at a lower rate.

Two Account Types, One Integrated Solution

Medicare Set-Aside Account

This account covers exclusively Medicare-covered, injury-related medical items, services, or expenses. Every claim is reviewed against current Medicare guidelines to confirm coverage and payment parameters. This is the most comprehensive MSP compliance tool available, and the foundation of responsible post-case medical fund management.

Medical Custodial Account

Not every injury-related expense fits within Medicare's coverage parameters. A Medical Custodial Account (MCA) handles the rest: non-Medicare-allowable medical costs, such as expensive attendant care, insurance premium co-pays, expenses triggered by MSA exhaustion, and, in some cases, structured living expense distributions. The MCA's flexibility protects funds from dissipation while ensuring every dollar is used according to the intent of the original arrangement. Periodic distributions can be structured to fit the individual's circumstances.

The Case for Managing Both Together

When both accounts are administered by Physician Life Care Planning, the benefits compound:

Flexible coordination between accounts allows for arrangements that address unique circumstances without creating MSP exposure
Both Medicare-allowable and non-allowable expenses are covered, with no cost shifting to the injured person
During any MSA exhaustion period, our team coordinates directly with CMS to ensure Medicare co-pay coverage continues uninterrupted
Bundled administration carries significantly reduced annual fees compared to managing accounts separately

What Physician Life Care Planning Brings to Administration

Two-Plus Decades of Experience: Our team has administered MSA arrangements longer than any other provider in the industry, including the very first professionally administered Medicare Set-Aside Arrangement ever completed.
Fiduciary Accountability: We correspond directly with Medicare, coordinate health benefits across providers, and negotiate claim reductions that translate into real savings on treatment, equipment, and pharmaceuticals.
Integration Support at No Charge: File review, mediation consultation, on-site training, and required arrangement language are provided regardless of whether administration services are ultimately engaged. We're invested in the outcome, not just the contract.

Supporting Your Practice From Day One

Physician Life Care Planning's consultants provide the agreements, documentation language, and procedural guidance needed to incorporate professional administration into any case, straightforward or highly complex. We have engineered compliant, workable solutions in every state in the country.

The earlier the administration is considered in the case lifecycle, the more options are available to all parties. Are you ready to discuss professional administration for a current or upcoming matter? Contact Physician Life Care Planning to connect with a specialist.