LMSAs

What You Need to Know About a Potential Review Process for LMSAs

Up to this point, there have not been any formal policies put in place by the Centers for Medicare and Medicaid Services (CMS) in regards to Liability Medicare Set-Asides (LMSA). Instead, two memos, Stalcup and CMS HQ, offer guidance on how the organization would like all entities to approach Medicare set asides (MSA). However, indicators began last summer that a change may be in the works, starting with an alert from CMS indicating that they were taking into consideration the creation of a voluntary process for reviewing liability MSAs. The process would review No-Fault MSAs as well.

Other Indicators of a Review Process for LMSAs

Since that time there have been several more indicators that the establishment of a review process is imminent. These include:

  • This past December, CMS released a Request for Proposal (RFP) for their Workers’ Compensation MSA contractor. It has been indicated that the contractor would also review LMSAs, breaking them down into two categories based on the settlement. These categories are full reviews and cursory reviews and are slated to start in July of 2018
  • According to documentation by CMS, LMSAs and NFMSA will have notated fields on the agency’s Common Work File. Additionally, request for payment for services will be denied if beneficiaries have open LMSA or NFMSA records.

Potential Impact

According to CMS, under this policy, up to 11,000 cases will require a full review, while 40,000 cases will need a cursory review. Generally speaking, it’s critical to make sure that you and your clients keep Medicare in mind when it comes to settlements and the future medical expenses that liability MSAs are used for.

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Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.

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