CMS taking up to 6 months for WCMSA approvals

Medicare Set-Aside Blog on January 24, 2011 | Posted by

Analytics from our CMS submission department are indicating a slowdown in the CMS WCMSA review process. Most submitted cases in 2010 took between 60-90 days for approval assuming no WCRC requests for additional information. Lately we are seeing a 90-day standard for relatively simple cases with 120-150 days not uncommon for a more complex case. Outliers are in the six-month range.


Perhaps volume to the WCRC/CMS is increasing due to greater compliance fears brought on by Mandatory MSP reporting. Maybe the WCRC is short staffed and cannot afford to replace workers given the tight budget they operate under. I suspect it is a combination of the two. What does this mean to you? Well if “you” are the carrier or self insured it means $6,500 to $13,000 in additional indemnity payments assuming a $500 per week comp rate. 


Don’t forget, when you send a case to CMS for approval sometimes you get the stick before you get the carrot.