Medicare Set-Asides and Medicare Compliance

By Shannon Metcalf The Centers for Medicare and Medicaid Services (CMS) is expanding the existing Section 111 reporting process to capture information on all workers’ compensation claims involving Medicare beneficiaries that receive a settlement (i.e., TPOC) and funding for a Workers’ Compensation Medicare Set-Aside (WCMSA), regardless of whether the workers’ compensation settlement was reported to […]

The Centers for Medicare & Medicaid Services (CMS) Removes Maximum Time Limit to use Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Amended Review Process By Shannon Metcalf Do you have cases that you cannot settle due to an outdated, CMS-approved WCMSA?  If so, there is good news as CMS has changed the Amended Review process to […]

The Centers for Medicare and Medicaid Services (CMS) issued an updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide – Version 3.5, on January 10, 2022. In that Reference Guide, CMS reiterated that submitting a WCMSA proposal for review is never required, but is recommended, as the WCMSA review process is “the only process that […]

The Centers for Medicare and Medicaid Services (CMS) issued an updated Section 111 NGHP User Guide – Version 6.4, on June 11, 2021. CMS will now allow the termination of ORM if the following criteria are met. Where there is no practical likelihood of associated future medical treatment, which is reflected by meeting ALL of the following: […]