CMS Rings in the New Year with an Updated WCMSA Reference Guide

The Centers for Medicare and Medicaid Services (CMS) wished us all a Happy New Year by releasing the latest version of the Workers’ Compensation Medicare Set Aside (WCMSA) Reference Guide on January 4, 2019. The noted updates are as follows:

·     To eliminate issues around Development Letter and Alert templates auto populating with individual Regional Office (RO) reviewer names and direct phone numbers, these will now display the generic “Workers’ Compensation Review Contractor (WCRC)” and the WCRC customer service number “(833) 295-3773” (Appendix 5). 

·     Per CMS’ request, certain references to memoranda on have been removed. 

·     The CDC Life Table has been updated for 2015 (Section 10.3). 

·     Updates have been provided for spinal cord stimulators and Lyrica (Sections 9.4.5 and 

While the above bullet points are specifically highlighted as updates, it is worth mentioning that there are several instances within the WCMSA Reference Guide where CMS highlights the fact that the submission of a Medicare Set-Aside (MSA) to CMS for approval is a voluntary process. However, the WCMSA Reference Guide goes on to indicate that receiving CMS approval of an MSA is “the only process that offers both Medicare beneficiaries and Workers’ Compensation entities finality, with respect to obligations for medical care required after settlement, award, or other payment occurs.”  While, the workers’ compensation settlement community continues to explore alternatives to CMS approval including Evidence Based Medicine (EBM) MSAs, and other non-submission programs, the goal of these approaches should always be to avoid shifting the burden of paying for post-settlement treatment to Medicare.  

To view the updated WCMSA Reference Guide in its entirety, please click here.

CMS Considers Expanding MSA Review Process to Include LMSAs

The Centers for Medicare and Medicaid Services (CMS) released a statement on its website indicating it is considering an expansion of its voluntary Medicare Set Aside (MSA) review program to include “the review of proposed liability insurance (including self-insurance) and no-fault insurance MSA amounts.”  While nothing is imminent for now, CMS did state that they will seek opinions from the community stakeholders on how best to implement this possible expansion. 

Legacy Claim Solutions will certainly continue to monitor this development and release updates on our blog and social media outlets as they become available.


Medicare’s Commercial Repayment Center Doubles Collections in 2015

The Commercial Repayment Center (CRC), the national contractor enlisted by the Centers for Medicare and Medicaid Services (CMS) to identify and recover payments mistakenly made by Medicare, doubled its collections in FY2015 from Group Health Plans (GHPs) according to its latest report to Congress.  Medicare may make a payment for medical treatment when the insurance information for the plan that should pay first is unknown.  These payments are commonly referred to as conditional payments.  In those instances, CMS will seek reimbursement for the payments they made on behalf of the Medicare beneficiary.

In FY2015, the CRC identified over $290 million in conditional payments, and collected nearly $150 million of that back on behalf of the Medicare program.  All of the CRCs work to date has focused on GHP recovery efforts, however in FY2016, their efforts will expand into Non-Group Health Plans (NGHPs) which include liability, no-fault, and workers’ compensation plans.  While a process has always been in place to collect from NGHPs, it can be reasonably assumed that these collection efforts will be much more aggressive and efficient in 2016.  Primary NGHP payers should be prepared to properly address the efficiency of these new collection efforts.

Other highlights of the report include:

  • The nearly $150 million dollars in net collections represents an increase of nearly 150% in collections over the previous fiscal year.
  • Taking into account contractor administrative costs totaling over $24 million, CMS received a return of over $125 million to the Medicare trust fund as a result of the CRCs collection efforts in FY2015.
  • The CRC introduced the Commercial Repayment Center Portal, which is a web-based tool that gives debtors a method to electronically manage their debt identification and repayment processes.

To read the report in its entirety, please click here.