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John Bair
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CMS Releases Updated WCMSA Guide


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Last week, CMS released an updated Workers’ Compensation Medicare Set Aside (WCMSA) Reference Guide.  The new version of the guide includes the following additions:

  • The five most common omissions from WCMSAs that result in development requests (Section
  • General information on the background of WCMSA reviewers (Section 9.4.2)
  • Considerations and resources used by the Workers’ Compensation Recovery Contractor (WCRC) to guide the review (Section 9.4.3)
  • Guidelines the WCRC uses for medical reviews, including documentation requirements, examples of certain types of medical cases and topics, and the guidelines that the WCRC follows when reviewing prescription medication allocations (Sections 9.4.4, 9.4.5,, and
  • Information about what payment history (inc. medical, indemnity and expenses) should and should not be submitted with the WCMSA proposal (Section 10.1.8)

The new additions are a helpful review for those who want more specifics on the review process.  While there is still work to do on the part of CMS to standardize the MSA review process, the updates are a good step in the right direction, at least for Workers’ Compensation cases.

The updated WCSMA review guide can be viewed here.

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MSA Allocations: Should You Get a Second Opinion?


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