Category Archives: WCMSA

Administration, Blog, Medicare Secondary Payer News, Medicare Set Aside, WCMSA

On 2/11/2014, CMS issued an important request for comment to expand WCMSA Re-Review Process.  Today, the WCMSA Re-Review process is limited to situations where: 1) CMS has notified the submitter of missing documentation; or 2) A mathematical error was made by Medicare’s review contractor of the WCMSA.  These limited situations have proved less than adequate for most situations where obvious errors could …
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New WCMSA Reference Guide is Now Available

06 Nov 2013 Roy Franco No Comments

Blog, Medicare Set Aside, WCMSA

Today, CMS released its latest Reference Guide for WCMSA reflecting additional enhancements to the WCMSA process.  Stakeholders will be notified of these proposed changes prior to implementation. Please continue to monitor the WCMSA website for updates. The following sections of the Guide have been enhanced or added: 9.4.1.1 – Most Frequent Reasons for Development Requests: The five most common omissions as …
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Blog, WCMSA

Several amendments to O.G.G.A. Section 34-9-200 (Georgia Workers’ Compensation Act) recently took effect after passing the Georgia legislature by unanimous vote.    One amendment, noteworthy for Workers’ Compensation Medicare Set Asides (WCMSA) is a new 400 week limit imposed on medical benefits for claims occurring on or after July 1, 2013 for non-catastrophic injury claims.   This change in the law harmonizes …
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Blog, WCMSA

CMS has published a “Helpful Hint” document which outlines areas of WCMSA submissions that frequently become an obstacle.  CMS explores the following twelve areas:  Incomplete Medical records for the last two years of treatment  Exclusion of pertinent medical records or submitting too many records.  Insufficient proof of medications, dosages and frequencies for the last two years of treatment.  Carrier payments …
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New WCMSA Reference Guide Summary

15 Apr 2013 admin No Comments

Blog, WCMSA

The attached Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted to the CMS.gov webpage.  This reference guide was created to help explain the WCMSA approval process and to serve as a reference guide for those electing to submit their WCMSAs to CMS for approval. The reference guide consolidates information currently found within the Workers’ Compensation Agency Services …
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Blog, WCMSA

On October 2, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Sponsors concerning the transition to Part D Coverage of Benzodiazepines and Barbiturates beginning in 2013. Effective June 1, 2013, all  Workers’ Compensation Medicare Set-Aside (WCMSA) proposals submitted to CMS for a review of the adequacy of the proposal amount are to include …
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New WCMSA Reference Guide Posted

01 Apr 2013 Jesse Hamby No Comments

Blog, Medicare Set Aside, WCMSA

A new Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide has been posted and is available for download below. This reference guide was created to consolidate  information currently found within the Workers’ Compensation Agency Services webpages and CMS Regional Office Program Memorandums, while providing WCMSA information to attorneys, Medicare beneficiaries, claimants, insurance carriers, representative payees, and WCMSA vendors.   Please continue …
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WCMSA

The WCMSAP or Workers’ Compensation Medicare Set-Aside Portal has been improved to allow for two type of reconsiderations. These reconsiderations have been broken down by CMS into the follow two options: Option 1 If you believe CMS’s determination contains obvious mistakes (e.g., a mathematical error or failure to recognize Medical records already submitted showing a surgery, priced by CMS, that …
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Allocation, Medicare Conditional Payments, Uncategorized, WCMSA

On December 17, 2012 CMS announced they will be updating the life tables that allocators use when calculating life expectancy in WCMSAs. The impact will be an overall increase in life expectancy, although minimally, which will result in slightly higher costs in some situations. It is important to know that if a file has a pending WCMSA timely submission is …
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Blog, Medicare Set Aside, WCMSA

Katie A. Fox, MSCC – VP Medicare Compliance On August 1, 2012 CMS released yet another Memorandum providing guidance to MSA Allocators, as it pertains to pricing for Transcutaneous Electrical Nerve Stimulation (TENS) units included within submitted Workers’ Compensation Medicare Set-Aside (WCMSA) proposals.   CMS has defined Chronic Low Back Pain (CLBP) as the following: “an episode of low back …
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