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 18.104.22.168)
- 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, 22.214.171.124, and 126.96.36.199)
- 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.
A West Point graduate where he served as captain and military aviator, John Bair continues his commitment to our country through his efforts within the settlement planning industry. He has represented families of victims lost in the Flight 3407 crash, offered pro bono services to the families of 9/11 victims and drafted the first consumer protection bill for plaintiffs (H.R. 3699).