You may be familiar with the 31-page guide to self-administration that The Centers for Medicare & Medicaid Services (CMS) provide for injured parties. This has recently been updated with a few changes outlining the Workers’ Compensation Medicare Set-Aside (WCMSA) process. To read the full updated toolkit, click here.
What is a WCMSA and Why is the Toolkit Important?
A WCMSA is a Workers’ Compensation Medicare Set-Aside. You may have received this if you settled a workers’ compensation case and have received either a lump-sum or structured settlement. The WCMSA self-administration toolkit helps provide more information about the self-admin process, provides examples of letters and bills, and gives insight into special circumstances.
So What’s Changed?
- Section 8: Page 9 - Final Depletion of Funds
New Addition: “Note that CMS will continue to deny claims related to the WC injury until final exhaustion attestation is received and documented. Attestation is highly important to ensure claims are paid properly after exhaustion.”
- Section 9: Page 10 - Reporting Changes - Medicare Entitlement Status
New Addition: “You may continue to use those funds to pay for care related to the settled SC injury” (We speculate SC may be a typo for WC).
How These Changes Affect You
Keep in mind that CMS is becoming more adamant about proper spending of WCMSA funds and are vigilantly looking for attestation of fund exhaustion before paying stepping in to pay future medical care. Meaning, in order to have Medicare become primary payer if your funds deplete, you need to prove you have appropriately spent your funds on injury-related expenses only and notify them that you have exhausted your account.
In the previous version of the WCMSA self-administration toolkit, it was unclear that if you become Medicare-ineligible while your WCMSA still has funds, you can use the rest of your funds for treatment on your injury. Now, you are assured that if you have properly spent your funds and your Medicare Eligibility Status changes, you are able to continue to treat using WCMSA funds.
Thinking About Self-Administering?
Self-administration is no easy task, but our tool, Amethyst, gives members resources to help them self-administer properly and efficiently. Our members save on average 21% on prescriptions and treatments, they never have to touch a bill, and we provide them with the WCMSA toolkit and other interactive and helpful reporting tools to assist them with the process.