Workers' Compensation Medicare Set-Aside (WCMSA)

		Workers' Compensation Medicare Set-Asides General information

MSA QUESTIONS? 770-374-3697

UPDATE 1/11/08
Major new legislation. The Federal Government has passed new legislation that will be requiring parties to report the terms of settlements. Those that don't comply could face $1,000/day in penalties. For more info click here.

UPDATE 12/01/07
The lack of updating has been due to the author moving from a private law firm to MedAllocators, Inc. Now that the move has been complete, updating will be more frequent. Thanks for your patience.

UPDATE 10/11/07
Here is an article about some problems New Jersey is facing with MSAs.

UPDATE 10/5/07
Prescription Drugs
It is possible that CMS will issue a new policy memo before the end of the year that will provide guidance as to how to price for prescription drugs.

UPDATE 8/21/07
REMINDER!
New WCMSA submission address effective August 27, 2007 --

CMS c/o Coordination of Benefits
Contractor P.O. Box 33849
Detroit, MI 48232

UPDATE 7/16/07

Here is a sample consent form to be used to obtain conditional payment information from the MSPRC.

UPDATE 7/5/2007

My blog has been updated. Check it out for some hints and tips.

http://wcmsainfo.blogspot.com/

UPDATE 5/3/07

Due to popular demand, we have created a FAQ. Download it here. (PDF).

UPDATE 4/9/07

Here is our latest newsletter concerning contacting CMS about an MSA proposal and what party is entitled to do so. Please read this before you decide to let another party be responsible for the MSA.

CMS' Draconian Contact Policy (PDF)

UPDATE 3/15/07

Check out our blog for hints and tips to the MSA process.

WEBSITE UPDATE 2/22/07

We added a discussion about condition payments because so many people were asking about this confusing part of the process.

CMS UPDATE 2/8/07

Conditional payments and prescription drugs
Download it here. (pdf format)

CMS UPDATE 10/2/06

There is a new company that is processing conditional payments. It is called the Medicare Secondary Payer Contractor (MSPRC). It is going to be assuming all duties for calculating and reporting conditional payments. It can be reached at 866-677-7220.
For more information click here.

CMS UPDATE 06/21/06

Conditional payout update. It has been reported that it is taking up to a year to obtain conditional payout information form the regional suppliers (e.g Blue Cross/Blue Shield). Plan ahead and make your requests for conditional payout information as early as possible. For detailed instructions on how to request the information click here.

CMS UPDATE 04/25/06

CMS has changed it threshold requirements. It will only be approving WCMSA where the claimant (employee) is Medicare eligible and the total settlement amount is great than $25,000. The previous amount was $10,000. This means that CMS will be reviewing and approving even fewer files. See the whole text of the latest CMS Policy Memo here.

According to federal law, Medicare is precluded from paying for a beneficiary’s medical expenses when payment “has been made or can reasonably be expected to be made under a workers’ compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance.”

In other words, employers and employees cannot shift the responsibility of paying for injuries associated with a worker's compensation (WC) claim to Medicare. When a WC claim is settled, Medicare requires that both the employee and the employer take Medicare's interests into account and protect Medicare from having to pay for any of the medical expenses associated with the employee's injuries.

Federal law (42 U.S.C. § 1395y(b)) not only establishes that Medicare is a secondary payer to WC, but also that Medicare has a priority right of recovery over any other entity to the proceeds of any settlement. To the extent that Medicare has made any “conditional payments”, Medicare will recover those payments pursuant to 42 C.F.R. § 411.47.

The Centers for Medicare and Medicare Services (CMS) enforces the provisions of this federal law. With the cooperation of each State's board of worker's compensation, CMS evaluates Medicare recipient's records to determine if there is a WC claim that should be responsible for the medical expenses instead of Medicare. If CMS determines that Medicare has made improper payments on behalf of an employee (CMS calls these "conditional payments"), it can seek recovery of those payments from the employer, the employee, and in certain circumstances, the attorneys involved in the settlement of the case. Under certain conditions CMS can recover double what it has paid out on behalf of the employee.

Large employers, risk managers, insurance adjusters, Medicare recipients, and workers' compensation attorneys from all over the country are concerned about this complicated hurdle CMS has created when a WC claim is settled (or trying to be settled). If Medicare's interests are not adequately protected then all the parties involved could face legal action from Medicare and a demand for double damages.

Still have questions? Click here to read more.

Click here for a more comprehensive article about the whole process.
(pdf format)