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Workers’ Compensation FAQs
Find out the most common questions about Workers’ Compensation in this downloadable version of WC FAQs!
Workers' Compensation
Medicare Set Asides
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Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide
This guide was written to help you understand the process used by the Centers for Medicare & Medicaid Services for approving proposed WCMSA amounts.
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Medicare Set Asides FAQs
Find out the most common questions about Medicare Set Asides in this downloadable version of Medicare Set Asides FAQs!
CMS Documents
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CMS Memo: Q&A for Workers’ Compensation Medicare Set-Aside Arrangements
This memorandum supersedes the Part D and Workers’ Compensation Medicare Set-aside Arrangements (WCMSA) memorandum that was published on December 30, 2005.
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Guidance for Submission of a WCMSA Proposal
This memorandum reiterates guidance provided in CMS’ July 23, 2001, July 11, 2005, and April 25, 2006 procedure memoranda regarding CMS’ WCMSA) proposal review thresholds…
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Lump-sum Payments
The document discusses lump-sum commutation of future benefits and lump-sum compromise settlement.
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Workers’ Compensation: Commutation of Future Benefits
This Regional Office letter clarifies CMS’ policy concerning how the Regional Offices evaluate and approve WC lump sum settlements to help ensure that Medicare’s interests are properly considered.
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Items and Services Not Covered Under Medicare
This publication provides information on the four categories of items and services not covered under Medicare and applicable exceptions.
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Medicare & Other Health Benefits: Your Guide to Who Pays First
If you have Medicare and other health coverage, each type of coverage is called a “payer .” When there’s more than one payer, “coordination of benefits” rules decide who pays first.
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Chapter 3: MSP Provider, Physician, and Supplier Billing Requirements
Contractors are required in professional and public relations activities to inform providers, physicians, other suppliers, and beneficiaries about the MSP provisions and that claims for services to beneficiaries for which Medicare is the secondary payer must be directed first to the primary plan where there is primary coverage for the services involved. The Medicare law…
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Chapter 2: MSP Provisions
10 – Medicare Secondary Payer Provisions for Working Aged Individuals 10.1 – Individuals Subject to Limitations on Payment 10.2 – Individuals Not Subject to the Limitation on Payment 10.3 – The 20-or-More Employees Requirement 10.4 – Working Aged Exception for Small Employers in Multi-Employer Group Health Plans (GHPs) 20 – Medicare Secondary Payer Provisions for…
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Chapter 1: MSP Background and Overview
In 1980, Congress enacted the first of a series of provisions that made Medicare the secondary payer to certain additional primary plans.
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Medicare’s Interest: Lump Sum or Structured Settlement
Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services
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Exclusions from Coverage and Medicare as Secondary Payer [Part 1]
Notwithstanding any other provision of this title, no payment may be made under part A or part B for any expenses incurred for items or services…
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CMS Prescription Drug Set-Aside Guidance for Submitters
Since the publication of the April 3, 2009 CMS policy memorandum announcing prescription drug reviews, which becomes effective June 1, 2009, submitters of Workers’ Compensation Medicare Set-aside Arrangements (“WCMSAs”) have raised several questions concerning how certain situations will be treated by CMS and the Workers’ Compensation Review Contractor (“WCRC”).
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Life Care Plans Prepared by Non-Treating Physicians
When the parties to a Workers’ Compensation (WC) settlement present CMS with “life care plans” or similar evaluations prepared by non-treating physicians to support and justify their proposed Workers’ Compensation Medicare Set-aside Arrangements (WCMSA), Medicare will consider accepting such evaluations if the physician does all of the following:
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Commutation vs. Compromise
One of the distinctions that Medicare regulations and manuals make between compromise and commutation cases is the absence of controversy over whether a WC carrier is liable to make payments.
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WCMSA and Revision of the Low Dollar Threshold for Medicare Beneficiaries
The purpose of this memorandum is to replace Q/A #2 of the July 11, 2005 Memorandum with regard to the Centers for Medicare & Medicaid Services’ low dollar WCMSA threshold for Medicare beneficiaries.
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Structured Set-Aside Arrangements
A WC Medicare Set-aside Arrangement can be established as a structured arrangement, where payments are made to the arrangement on a defined schedule to cover expenses projected for future years. In a structured Medicare set-aside arrangement, monies are apportioned over fixed or definite periods of time. In such cases, Medicare will not agree to cover…
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Rated Age Language
This memorandum clarifies the guidance provided in the Centers for Medicare & Medicaid Services (CMS) May 14, 2010 procedure memorandum regarding the Rated Age (RA) language to be included on WCMSA proposals
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Pricing Future Prescription Drug Treatment Costs
The purpose of this memorandum is to set forth CMS’ procedures regarding the methodology of pricing future prescription drug treatment costs/expenses in WCMSA proposals.
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Prescription Drugs for Medicare Beneficiaries
The purpose of this memorandum is to clarify guidance provided in the Centers for Medicare & Medicaid Services’ April 3, 2009 and July 1, 2009 procedure memoranda regarding prescription drugs…
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Pricing of Implantable Devices and Beneficiaries Requesting Termination of a WCMSA Account
This memorandum includes policy regarding the pricing of Implantable Devices and to replaces the policies regarding “Beneficiaries that Request Termination of a WCMSA.
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Workers’ Compensation: Commutation of Future Benefits [Update]
This memorandum replaces the policy that was outlined in the answers to questions in the all associate regional administrators (ARA) memorandum.
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Part D and Workers’ Compensation MSA: Questions and Answers
This memorandum includes policy regarding the inclusion of prescription drugs that Medicare will cover as of January 1, 2006, in Workers’ Compensation Medicare Set-aside Arrangements (WCMSAs).
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Workers’ Compensation Frequently Asked Questions (Part 4)
Use of WC Fee Schedule vs. Actual Charges for WC Medicare Set-aside Arrangement? Self-administration of a WC Medicare Set-aside Arrangement?
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Workers’ Compensation Frequently Asked Questions (Part 3)
Medicare Secondary Payer (MSP) – Workers’ Compensation (WC) Additional Frequently Asked Questions
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Workers’ Compensation Frequently Asked Questions (Part 2)
Medicare Secondary Payer — Workers’ Compensation (WC) Additional Frequently Asked Questions
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Workers’ Compensation Frequently Asked Questions (Part 1)
What statutory law, regulations, or Federal case law supports/allows CMS to review proposed settlements of injured workers who are not Medicare beneficiaries? When dealing with a WC case, what is “a reasonable expectation” of Medicare enrollment within 30 months? How does Medicare determine its interests in WC cases when the parties to the settlement do…
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Life Expectancy in Workers’ Compensation Medicare Set-Asides Proposal
The purpose of this memorandum is to include policy regarding the exclusive use of the Centers for Disease Control (CDC) Table 1 (All American Table) when determining life expectancy…
