April 17, 2024 • ComplianceLegislative & RegulatoryNews

Preparing for Section 111 WCMSA Reporting: Key Technical and Professional Administration Considerations

The Centers for Medicare & Medicaid (CMS) hosted their second Section 111 Reporting of Workers Compensation Medicare Set-Asides (WCMSA) webinar on April 16, 2024. The webinar provided background on the expansion of Section 111 Total Payment Obligation to Claimant (TPOC) reporting that includes certain WCMSA fields. Attendees were encouraged to submit their questions ahead of the webinar.

The purpose of the webinar was to review the technical details for the MSA Fields, Error Codes, testing, implementation timeline and Civil Monetary Penalties (CMP’s). Chapter 7: Claim Response File can be referenced for further information on the technical details discussed by CMS during the call. The implementation was moved back from January 2025 to April 4, 2025 to allow Responsible Reporting Entities (RRE) to prepare and test the additional fields. RRE's should be working with their Section 111 Reporting vendors to review these changes and participate in the testing process to ensure a smooth transition come April 4, 2025.

CMS emphasized the importance of Section 111 Reporting and the proper coordination of benefits to protect the Medicare fund. The WCMSA reporting requirement applies to both CMS-approved and non-approved Medicare Set-Asides (MSAs). CMS reminded the listeners following the TPOC reporting of WCMSA data fields a code W will be entered into the Common Working File (CWF) to signify there are MSA funds to pay for the injury related condition otherwise covered by Medicare. CMS also hopes this will create greater awareness for injured workers on the MSA and their responsibilities with annual attestations. CMS also expects settling parties to submit the settlement documents.

As mentioned in our prior update, CMS will collect the WCMSA data fields to the Claim Input File. The reporting will be prospective with TPOC dates of April 4, 2025, and after. CMS reviewed the new data fields, what causes rejections, errors, and hard edits. Testing is scheduled to begin 10/7/2024 and RRE’s can review Section 9 of Chapter 4 in the NGHP User Guide to learn more about the testing environment.

CMS indicated Civil Monetary Penalties (CMP’s) wouldn’t commence until two reporting cycles were met following the 4/4/2025 implementation. Failure to report with TPOC reporting by an RRE could result in other action by CMS.

Key Reminder: Professional Administrator Can Be Added After TPOC Completion

CMS mentioned submitting the professional administration companies’ EIN when submitting all of the final WCMSA TPOC data. It is important to mention that a professional administrator can be added to the file even after TPOC is completed. So if there is a settlement occurring, adding administration late in the settlement negotiations would not impact the TPOC reporting.

Take Precaution with Professional Administration

Now that CMS will have visibility into both submitted and non-submitted MSAs and thereby the urgency for proper administration of the funds is even higher, learn how professional administration ensures compliance with CMS' guidelines and protects medical funds post-settlement. 

How Professional Administration Simplifies WCMSA Reporting

Stay Updated

Read more from Ametros on CMS' latest industry updates regarding Section 111 WCMSA Reporting and an updated WCMSA Reference guide here:

There were some technical issues connecting to the presentation, CMS will see if a copy of the presentation can be made available and may schedule additional time for a question-and-answer session.

 If you have questions about ensuring WCMSA compliance post-settlement with professional administration or about CMS' recent updates, please feel free to reach out to our team of experts.

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