Updated Guides Issued: WCMSA Reference Guide and Section 111 Reporting Guide

CMS, Medicare Set-Asides, MSP News on October 4, 2018
Posted by Jean S. Goldstein, JD, CMSP

An updated Workers’ Compensation Medicare Set-Aside (WCMSA) reference guide has been issued.  The revised guide, version 2.8, can be found here.

The revised WCMSA reference guide includes the following updates:

  • Fields formerly labeled as “HICN” have been relabeled as “Medicare ID” and can accept either an Health Insurance Claim Number (HICN) or the new Medicare Beneficiary Identifier;
  • The link to the CDC Life Expectancy Table has been updated; and
  • The verifying jurisdiction and calculation method for fee schedule pricing for submitted MSAs has also been updated. 

Of note, no changes to the life table have been made.  With respect to fee schedule pricing, it is generally dependent upon where the workers’ compensation claim is filed, and the updated guide provides an example of how pricing is determined.

The release of the updated WCMSA reference guide is also accompanied by the release of a revised MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting Guide.  The only minor change in the updated Section 111 Reporting Guide is a change in the escalation process, which simply notes a new Electronic Data Interchange support contact.  The updated reporting guide may be found here.

As always, we will continue to monitor all CMS issued correspondence, and keep you updated of changes that may impact your claims.