Updates Added to the WCMSA Reference Guide

CMS, Medicare Set-Aside Blog, MSA Administration on February 1, 2016 | Posted by Jean S. Goldstein, JD

An updated and revised WCMSA reference guide has been issued. The revised guide, version 2.4, can be found here.

The revised WCMSA reference guide only has one update, which specifically addresses ongoing responsibility for medicals (ORM) recovery activities.  Specifically, the updated guide notes that “[i]f Medicare is pursuing recovery from the WC insurer, the beneficiary, attorney or other representative will receive a copy of the recovery correspondence sent to the WC insurer.” As we recently reported, this update comes on the heels of CMS’ recent changes and enhanced functionality of the Medicare Secondary Payer Recovery Portal, including the important announcement that “[a]n insurer and their authorized representatives can initiate the Final CP process on their insurer-debtor case as long as a settlement is pending on the case and no outstanding Ongoing Responsibility for Medicals (ORM) exists.”

The remainder of the WCMSA reference is unchanged.  However, we did want to note that since CMS’ last update to the reference guide, we have seen far less unnecessary developments for unrelated documents.  With far fewer developments for unrelated, irrelevant, and unnecessary information, we are happy to report that CMS’ turnaround time has also greatly improved.  Over the last year, the CMS review contractor and CMS Regional Offices have shown significant improvement in turnaround times.  Turnaround times average 14 days, from the time of submission of a Medicare-Set Aside (MSA) to the time an approval is received.  Long gone are the days when an approval would take well over a year to be completed.

We continue to monitor CMS trends, changes, and any MSP compliance issues that may arise, and will keep you updated regarding these issues as we head into 2016.