Catching Up With Workers’ Compensation Medicare Set-Aside Arrangements

Changes to Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs) are made regularly to ensure that WCMSAs can act appropriately across a wide array of different cases. If your client has suffered a workplace injury, you’re undoubtedly up to your neck in legal literature. Before your client can procure their award, you have to win their case. In many cases, it’s hard to focus on both without enlisting a consultant who can offer your client Medicare set aside services. If you want to help your client win their case, it’s important to stay updated on WCMSA rules and regulations.

Revised Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide

The WCMSA Reference Guide was updated to version 2.6 midway through 2017. It can be found on the Centers for Medicare and Medical Services (CMS) website. It helps clarify existing policies and expands the criteria for WCMSA re-review submissions. Submitters can now request a re-review where CMS has already issued an amount, but the settlement is still pending and the approved medical care cost has changed. This revision also helped clarify how to work with states that use Utilization Review processes to defend prospective WCMSA amounts.

Consideration for Expansion of Medicare Set-Aside Arrangements (MSA)

CMS continuously alters and expands its voluntary Medicare Set-Aside Arrangements (MSA) review process to incorporate liability insurance and no-fault insurance MSA. To facilitate this expansion, CMS works closely with stakeholders to determine the best course of action for implementing the future expansion of voluntary MSA reviews.

Use of the Center for Disease Control (CDC) 2014 Life Tables

The Centers for Medicare and Medical Services (CMS) is now using CDC’s Table 1: Life Table for the total population: United States, 2014 as a metric for WCMSA life expectancy calculations.

WCMSAs and Opioids

CMS is well aware of the opioid crisis crippling the United States, and they’ve updated their considerations to better operate within the framework of the current problem. To ensure that the determination of WCMSA amounts adequately covers claimants’ needs for future medical services and medicine is suitable, CMS evaluates related policies and procedures on an ongoing basis.

WCMSA is constantly updated to better reflect the current state of American healthcare. Managing to keep up with every bit of news can be a daunting task, and your client will most likely suffer without a skilled consultant to assist you with the process of procuring a medicare set aside for personal injury.

For more information or to schedule a consultation, please submit our contact request form.

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.

TESTIMONIALS

"Coincidentally, on the day of a recent Synergy Seminar on Medicare & ERISA lien resolution I received a letter on an ERISA lien. This letter followed much back and forth between myself and the recovery vendor for BCBS. Despite my efforts they were adamant there would be no (zero)(zilch)(nada) reduction and provided case law to support their position. I tried Synergy’s Lien Resolution Services since I had just heard their Director of Lien Resolution speak. Synergy got them to reduce their claim by a third in less than ten (10) days. The result was quick and the fee very reasonable. If you have a tough ERISA lien and your typical efforts don’t work, give Synergy a try."

Michael S. Smith, Esq.
Lesser, Lesser, Landy & Smith, PLLC

"In my business as a plaintiff’s products liability lawyer, everything begins and ends with our clients. In our firm we never handle a significant case without the assistance of Synergy. Why? Very simple: we trust Synergy with our clients. Yes, Synergy only works with plaintiffs. And yes, they are highly technically proficient and know this business cold. But what makes them different from others is that they listen to our clients, make our clients comfortable with complex issues, and always put the interests of the client first. In my opinion, because of their unique ability to handle people with sincerity and compassion in their time of crisis, they stand head and shoulders above his competition."

Richard Newsome
Newsome Law Firm, Past President of Florida Justice Association

WordPress Image Lightbox