Medivest Blog - Company Updates, Industry News, and Insights

17/Dec/2024

On December 16th, Centers for Medicare & Medicaid Services (CMS) announced that 2025 recovery thresholds for physical trauma liability, no-fault and Workers’ Compensation settlements, judgments, awards or other payments by CMS (Settlements) will remain at $750. The full announcement can be read here.

This threshold does not apply to ingestion, implantation or exposure Settlements. The $750 threshold will continue to apply to Workers’ Compensation and no-fault insurance settlements as long as the entities do not have ongoing responsibility for medicals. As usual, there is no Section 111 reporting requirement for Settlements under $750, and CMS will not seek recovery for conditional payments/Medicare liens arising from below threshold Settlements.

Additional information regarding the methodology used to determine the threshold has been provided here.

For Additional Information

Medivest will continue to monitor news and updates from CMS, and will keep its readers up to date when important announcements are made. For questions about this chart or any other recent updates, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

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Sandy Simpson

11/Dec/2024

On December 6, 2024, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide to version 7.8. It has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 7.8 replaces Version 7.7 which was released on October 7, 2024.

MMSEA III – December 6, 2024 – NGHP User Guide Downloads 7.8

Chapter 1: Introduction and Overview

The updates listed below have been made to the Introduction and Overview Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter II: Registration Procedures

The update listed below has been made to the Registration Procedures Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

Chapter III: Policy Guidance

The updates listed below have been made to the Policy Guidance Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. A new section has been added that discusses Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs), within the workers’ compensation TPOCs section (Section 6.4.4).

Chapter IV: Technical Information

The updates listed below have been made to the Technical Information Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. A new section has been added that discusses Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs), within the workers’ compensation TPOCs section (Section 6.4.4.1).

Chapter V: Appendices

The updates listed below have been made to the Appendices Chapter Version 7.8 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. There are no changes for this version.

270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 6.0

The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

Medivest

05/Dec/2024

On November 26th, 2024, the Centers for Medicare & Medicaid Services (CMS) shared a new report titled Workers’ Compensation Medicare Set-Aside (WCMSA) Fiscal Year Statistics 2024. The report provides five fiscal years of data regarding Workers’ Compensation Medicare Set-Aside (WCMSA) Proposed Value and Workers’ Compensation Review Contractor Values (WCRC) from 2020 to 2024.

Analysis

There was a 5.6% decrease in the number of WCMSA allocation reports that were submitted to CMS for review from 15,743 in Fiscal Year (FY) 2023 to 14,862 in FY 2024. There was also a drop in average settlement value of 4.7% from an average of $159,976.93 in FY 2023 to only $152,487.15 in FY 2024.

Despite this drop in settlement values, the WCMSA proposals for allocation reports submitted to CMS remained relatively flat, only dropping less than 2/10ths of one percent from $70,887.33 in FY 2023 to $70,775.58 in FY 2024. Counterhighers from CMS, correspondingly remained relatively flat moving from its published increase between the submitted versus recommended amount of 22% in FY 2023 to an increase of 21% in FY 2024.

The biggest change in the WCMSA CMS review statistics in recent years is that in 2022, when Section 4.3 was first added to the Reference Guide, the average counterhigher jumped from a 13-15% increase for FY 2020-2022 to what may be a “new era” for the last two years being between a 21-22% increase. Taking the average of 14% from FY 2020 – FY 2022 to the average of a 21.5% counterhigher increase for FY 2023 – FY 2024, this amounts to 31% increase in the counterhigher percentages!

Proposed MSAs and Total Settlement Amounts

Pre-CMS review WCMSAs constituted around 46% of the total settlement amount in FY 2024 up from 44% in FY 2023.

Medical vs Rx

Medical items and services represented approximately 79.3 % of the approved MSA amounts, whereas Rx represented 20.7% of the approved WCMSA amounts in FY 2024. The medical portion was 76.9% in FY 2023 with Rx accounting for 23.04% of the MSA in FY 2023. In FY 2020 by contrast, the medical portion was 68.6% and Rx expenses represented 31.4% of approved WCMSA amounts. Rx expenses have declined by 34% since FY 2020 as a percentage of the WCMSA . While several factors are likely to be at play here, CMS’ use of sometimes aggressive NDCs to price drugs may be one culprit. Medivest consistently sees submitted MSAs priced using drug NDCs unavailable in the actual market, and well below market average.

Take Aways

While reviews by CMS could in theory include acceptances or even reductions in the amount proposed by submitters as counterlowers, those who submit WCMSA’s have come to know that CMS reviews of WCMSA’s most often come back in the form of a counterhigher. It is important to distinguish a counterhigher from the term counter offer used in contract negotiations. While the WCMSA submission process is entirely voluntary, CMS’s Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide (WCMSA Reference Guide) language and CMS operations consider the CMS review/approval response to be CMS’ final position on the acceptable amount to be set aside to protect Medicare’s future interests in the settlement, unless there is a successful Re-Review (allowed only for instances where there is a math error or the discovery of a document in existence prior to the time of submission but not included in the submission which is then allowed to be provided for the once only Re-Review opportunity). As a result, many in the industry say CMS uses the counterhigher to “voluntell” the parties the amount required to be set aside from their settlement for their WCMSA amount and that if an alternate amount is set aside or no amount is set aside, injury related medicals otherwise covered by Medicare could be denied by Medicare up to the settlement amount minus procurement costs instead of up to the CMS approval amount.

As background, total WCMSA submissions to CMS declined steadily between CMS’ FY 2020 and FY 2022, descending from 16,517 to 13,752, a reduction of almost 17% in three years. FY 2023’s 15,743 submission count seemed to have been a reversal of that trend until the 14,862 number for FY 2024 was reported. This seems to be the market shaking out the initial scare from Section 4.3. in which CMS had for the first time discussed “non-submit” or “evidence-based” MSA allocation reports as potential attempts to shift the burden of payment for injury related Medicare covered medicals to Medicare.

Proposed vs Recommended

While one can understand that CMS wants to protect the Medicare Trust Funds for both Medicare Part A and Part B, it does not seem to be productive for CMS to unfairly punish those who decide to voluntarily submit MSA’s in accordance with CMS WCMSA Reference Guide methodology. The statistics described above show that while the settlements have come down recently, the amount of the submitted WCMSA’s have not, so it’s not as if submitters have been lowballing their submissions. Those carriers who embraced a non-submit program in recent years to avoid higher WCMSA amounts associated with large counterhighers from CMS, may have not yet seen enough consequences to encourage a large return to voluntary submission practices.

The Big Question

These are statistics from those WCMSA’s submitted for approval, meaning they were written by industry-trained professionals in an attempt to match CMS’ recommended methodology. If the industry for those who submit have been consistent, but there has still been an increase in the counterhigher percentages, what has changed at CMS? While the fear in the stakeholder industry used to be focused on financial recovery by CMS under the Medicare Secondary Payer Act (MSP), could it be that CMS’s position concerning non-submitted WCMSA’s is evolving in the form of future Medicare denials for injured claimants who will be left to their own devices to attempt administrative appeals over those denials? The discussions of Section 4.3 of the WCMSA Reference Guide may have just the start of the new era, while CMS continues to build out its computer system in the background. Now, we are aware that there are new Section 111 Reporting requirements include the reporting of WCMSA amounts for all TPOC settlements involving current Medicare beneficiaries whether the WCMSA was submitted to CMS for review or not. Furthermore, the new Civil Monetary Penalty enforcement for untimely Section 111 reporting of ORM and TPOC applicable as of October of this year to be audited in October of 2025 seem to be clear additional steps of the new era, with additional data for CMS to continue to expand Medicare medical and Rx denials in the future. Routine reviews of business practices are prudent in any industry and as we head into another fiscal year, it is a great time to review your business practices to confirm your firm or company is taking the steps to help ensure best in class compliance standards that align with your clients’ interests and risk tolerances.

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or calling us directly at 877.725.2467.

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Sandy Simpson

07/Oct/2024

On October 7, 2024, the Centers for Medicare & Medicaid Services (CMS) updated the MMSEA Section 111 NGHP User Guide to version 7.7. It has been posted to the NGHP User Guide page, found here. The NGHP User Guide to version 7.7 replaces Version 7.6 which was released on July 2, 2024.

MMSEA III – October 7, 2024 – NGHP User Guide Downloads 7.7

Chapter I: Introduction and Overview (PDF)

Updates: The updates listed below have been made to the Introduction and Overview Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. The table describing system-generated emails has been updated to include information for the RRE ID Notification email that is sent once a user completes the initial registration function and the Successful Registration PIN email that is sent once vetting is successful on the Section 111 COB Secure Website (COBSW) (Table 7-1).

Chapter II: Registration Procedures (PDF)

Updates: The update listed below has been made to the Registration Procedures Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. The table describing system-generated emails has been updated to include information for the RRE ID Notification email that is sent once a user completes the initial registration function and the Successful Registration PIN email that is sent once vetting is successful on the Section 111 COB Secure Website (COBSW) (Table 6-4).

Chapter III: Policy Guidance (PDF)

Updates: The updates listed below have been made to the Policy Guidance Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. For clarification, a note has been added to indicate that settlements, judgments, awards, or other payments obtained entirely under the wrongful death theory of liability, which do not claim and release medicals, or have the effect of releasing medicals, are not required to be reported (Section 6.5.1.4).

Chapter IV: Technical Information (PDF)

Updates: The updates listed below have been made to the Technical Information Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide, as necessary. For NGHP claim files, a new “04” warning flag will be applied to claim response files with open ORM records when the later date of either the CMS Date of Incident on the claim record or the Part A Add Date is greater than 135 calendar days from the Start Date of the RRE’s submission period. Additionally, compliance flag fields have been renamed warning flag (Sections 6.1 and 6.9.1 and Chapter 7). The table describing system-generated emails has been updated to include information for the RRE ID Notification email that is sent once a user completes the initial registration function and the Successful Registration PIN email that is sent once vetting is successful on the Section 111 COB Secure Website (COBSW) (Table 12-1). The description of Response File disposition code 03 has been clarified (7.1).

Chapter V: Appendices (PDF)

Updates: The updates listed below have been made to the Appendices Chapter Version 7.7 of the NGHP User Guide. As indicated on prior Section 111 NGHP Town Hall teleconferences, the Centers for Medicare & Medicaid Services (CMS) continue to review reporting requirements and will post any applicable updates in the form of revisions to Alerts and the user guide as necessary. For NGHP claim files, a new “04” warning flag will be applied to claim response files with open ORM records when the later date of either the CMS Date of Incident on the claim record or the Part A Add Date is greater than 135 calendar days from the Start Date of the RRE’s submission period. Additionally, compliance flag fields have been renamed warning flag (Appendix C and Appendix G). The description of Response File disposition code 03 has been clarified (Appendix G).

270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities Version 6.0

Changes for This Release: The email address for contacting an Electronic Data Interchange (EDI) Representative has changed to COBVA@bcrcgdit.com. However, COBVA emails coming from CMS now show the address as COBVA@mail.cms.hhs.gov (Customer Support).

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

Sandy Simpson

03/Oct/2024

On September 23, 2024, CMS released new announcements regarding Civil Money Penalties. This follows other recent updates and webinars from CMS that have placed additional emphasis on reporting settlement details, and an even greater preference for claimants to use professional MSA administration.

A New NGHP Webpage for Civil Money Penalties

A new webpage for NGHP Civil Money Penalties (CMP) for Section 111 Reporting is now available. Click here to view it. The new webpage is a tool for Responsible Reporting Entities (RREs) to comply with Section 111 of the Medicare, Medicaid, and SCIP Extension Act. The RREs are required to report to CMS regarding the Medicare beneficiaries including information about liability insurance (including self-insurance), no-fault insurance, and workers’ compensation claims where the injured party is a Medicare beneficiary. The new page offers details on the CMP Final Rule, a CMP Workflow Chart, and more.

Expanding Reporting Requirements

The increased MSA mandatory reporting requirements fields enhance oversight and ensure proper coordination of benefits. Historically, CMS has had limited or incomplete information on MSAs which is why CMS has expanded the existing S111 mandatory reporting requirements. The expanded data fields will capture information on all WC claims involving Medicare beneficiaries who received a settlement.

Beginning April 4^th, 2025, all workers’ compensation settlements involving Medicare beneficiaries that include a MSA of $750 or more, must be reported to CMS, even if the settlement was previously reported voluntarily or did not previously meet the CMS review threshold for MSA submission, which remains at $25,000. For further details regarding reporting requirements, please refer to the NGHP User Guide.

A Reminder of the Expanded Data Reporting Fields

- MSA Amount
- MSA Period (# of Years)
- Funding Type (Lump Sum or Annuity)
- If Structured
- Initial Deposit Amount
- Anniversary (Annual Deposit Amount)
- Case Control Number
- Professional Administrator EIN

What Does All of This Mean?

CMS wants to be made aware of settlement details. The new NGHP CMP webpage is the most recent example that CMS is focused on S111 reporting, non-compliance, review of records for auditing to identify non-compliance, penalty amounts of non-compliance, and the process of how non-compliance decisions will be handed down.

On September 12, 2024, CMS presented a webinar (click here to view presentation) on Section 111 NGHP Mandatory Reporting for Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers’ Compensation. Additionally, a second webinar has been announced for another Medicare Secondary Payer & Civil Money Penalties webinar, scheduled for October 17, 2024, to provide a stage for any last-minute inquiries. CMS is taking every opportunity to promote its push for emphasis on receiving accurate and timely settlement information from RREs.

With the new expanded data requirements, very little will change in the way cases are handled by a professional administrator. On the other hand, claimants choosing to self-administer their MSA may find themselves exposed to greater risk of jeopardizing their Medicare benefits.

Reminder: Claimants who self-administer their MSA funds have hefty obligations so they do not jeopardize their Medicare benefits. These obligations include:

- - MSA funds held in an interest-bearing account
  - MSA funds may only be used for Medicare-covered and injury related expenses
  - Keep accurate record of expenses paid out of the MSA account
  - Coordination of health insurance benefits
  - Annual attestation reporting submitted to Medicare

Why Choose Medivest Asure for Professional Administration

With the additional responsibility and penalties looming overhead, doesn’t it make sense to work with an experienced Professional Administrator? Medivest was the first to professionally administer a MSA Account, and has been providing this service since 1998 – longer than any other company. Asure members have their MSA accounts managed by the Medivest team who will:

- - Ensure funds are spent down according to the allowable guidelines
  - Communicate with doctors, pharmacists, and DME suppliers for proper billing
  - Negotiate fees for medical services and future surgeries
  - Coordinate benefits with other health insurance plans including Medicare
  - Prepare required annual compliance documents for Medicare
  - Work with the medical providers and pharmacies of your choice
  - Protect Medicare entitlement by ensuring compliance with Medicare regulations

To download a Medivest Asure flyer, click here.

For Additional Information

Medivest

26/Sep/2024

Mandatory Reporting for Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers’ Compensation

CMS will be hosting a webinar regarding Certain Civil Money Penalties for NGHP Responsible Reporting Entities (RREs). The format will be opening remarks and a presentation by CMS that will include reminders about the Final Rule, the auditing process and important dates, followed by a question and answer session. RREs who would like to submit questions in advance of the webinar are encouraged to do so using the dedicated resource mailbox at Sec111CMP@cms.hhs.gov.

Date: October 17, 2024
Time: 1:00 PM ET

Webinar Link: https://cms.zoomgov.com/j/1602011678?pwd=e54vgVqZczEGeWbDf4hk95AeozMh47.1
Passcode: 145914

Or to connect via phone:

Conference Dial In: (833) 568-8864
Conference Passcode: 160 201 1678

Important Note: This is a public webinar and there is no pre-registration needed. The webinar link should only be utilized the day of the webinar. Due to the number of expected participants, please log in at least 10 minutes prior to the start of the presentation.

Additional information about the most recent updates from CMS can be found here. If you have questions on how topics discussed in this webinar may affect your clients or your company, please contact Medivest or call us at 877.725.2467.

Medivest

28/Aug/2024

Mandatory Reporting for Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers’ Compensation

CMS will be hosting a Section 111 NGHP Reporting webinar. The format will be opening remarks by CMS, a presentation that will include NGHP reporting best practices and reminders, followed by a question and answer session. For questions regarding Section 111 reporting, prior to the webinar, please utilize the Section 111 Resource Mailbox PL110-173SEC111-comments@cms.hhs.gov.

Date: Thursday September 12, 2024
Time: 1:00 PM ET

Webinar Link: https://cms.zoomgov.com/j/1619262037?pwd=VnY1RWFLTWc4RXN4RjZ5YzV4WDQvdz09

Passcode: 315331

Or to connect via phone:

Webinar Dial In: 1-833-435-1820
Webinar ID: 161 926 2037

Medivest

26/Aug/2024

It’s been a busy 2024 for CMS. Since February 2024, over half a dozen updates have been made to Section 111 Mandatory Insurance Reporting and CMS’s policies.

Ultimately, these new changes increase awareness and focus on post-settlement MSA spending, emphasizing the importance of utilizing a competent professional administrator.

What this means is you need Medivest’s Asure Pro-Admin more than ever to navigate these changes and keep all settlement parties from getting penalized for non-compliance!

**Medivest’s Asure Pro-Admin Helps Protect All Parties**

Asure Pro-Admin:
Professional Administration for MSA Accounts by the professionals

Medivest claimant accounts saved over 70% of what they were billed by providers over the last 12 months
An average of 23.3% of the original MSA is disbursed to the surviving beneficiary or reversionary interest party upon the claimant’s death
During our 27 years of business, we have only had a 2% member cancellation rate due to unforeseen reasons other than death. This remarkable retention rate underscores the value and satisfaction our members experience with our services
Medivest members and clients can be confident that a Claims specialist will review every line item on every bill submitted, ensuring proper coordination of benefits

Self-Asure:
The DIY solution with Medivest’s expert support

Don’t go it alone! Use Self-Asure to navigate the CMS government maze
The Self-Asure Self-Administration Kit, an innovative tool first created by Medivest, is good for injured parties with a small MSA that is designed to exhaust in a short length of time. Self-Asure provides guidance to individuals who opt to manage their own MSA, and pairs it with phone support and medical bill review from Medivest’s experienced Member Services team.
However, a Self-Administration Kit still has limitations, particularly if multiple bills come in at once. So the settlement parties need to carefully consider Medivest for professional administration per CMS’s recommendation.

4 Asure:
Easy approach to navigate settlement compliance for Insurer, Self-insured, and TPA without adding ANY work to the adjuster’s already full plate. The streamline process of:

Medicare Status check/lien investigation to determine if MSA is recommended
Structured Settlement consultant for rated age and MSA funding
MSA Allocation Report (if needed)
Professional Administration of MSA

CONTACT MEDIVEST TODAY – WE ARE HERE TO HELP!

877-725-2467 (Monday – Friday 8am to 5pm EST)

Summary/Takeaways

MMSEA Section 111 Mandatory Insurer Reporting (NGHP)

Medicare is ramping up its data collection. New fields have been added to the Section 111 Claim Input File to capture WCMSA information on all Workers’ Compensation (WC) claims involving Medicare beneficiaries.

These data collections will have a significant impact on reporting and WCMSA compliance for the use of non-submit and Evidence Based Medicare Set-Aside arrangements. By capturing this new data, Medicare will know when funds have exhausted, make more appropriate determinations regarding the coordination of benefits, and more thoroughly investigate which injury related medical payments they should be denying. The new fields will become effective 4/4/25.

Self-Administration Toolkit, Version 1.6

Under the WCMSA Guidelines, CMS has the right to recovery. Over 1/3 of Medicare recipients have a Medicare Advantage Plan (MAP). These plan providers have asked for the same recovery rights that CMS has. The last sentence in Section 4.1.3 of the new Self-Administration Toolkit takes the first steps to clearly spell out that CMS is extending their rights of recovery to MAP partners:

If you are enrolled in a Medicare Advantage or prescription drug plan, please contact your plan to discuss your WCMSA, if you have not already done so.

WCMSA Reference Guide, Version 4.3

In the latest update of the WCMSA reference guide, Medicare Advantage Plans continue to be spotlighted. In Section 4.1.3, CMS states:

CMS notifies Part C and D plan sponsors that a WCMSA has been approved and instructs plan sponsors to conduct Medicare Secondary Payer (MSP) investigations. However, CMS does not relay WCMSA details to plan sponsors… The administrator must provide details concerning treatments and medications used exclusively to treat a related illness or injury to the plan sponsor so the sponsor may avoid making primary payment in the future.

CMS instructs the MAP sponsors that a WCMSA exists but doesn’t share any specific details of the MSA. It seems inevitable that this will create a communication breakdown at some point. The onus of communication is put entirely on the administrator. For a professional administrator, this will be a common (and new) task, but for someone attempting to self-administer their WCMSA, a whole new world of responsibility and questions are about to be spotlighted.

For the full information on these alerts from CMS, please visit the “What’s New” page of their website.

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467 (Monday – Friday 8am to 5pm EST).

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Sandy Simpson

02/Aug/2024

The Centers for Medicare & Medicaid Services (CMS) released a revised Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (“Reference Guide”) Version 4.1 on August 1, 2024. This Reference Guide replaces Version 4.0 which was released on April 1, 2024. There are a few notable changes when comparing the two Reference Guides.

Changes in Version 4.1 of this Guide Include the Following Changes

By CMS’ request, the guide has been updated with details about WCMSA coordination with other health insurers (Section 4.1.3).

To download the new WCMSA Reference Guide v4.1 click here.

This guide reflects information compiled from all WCMSA Regional Office (RO) Memoranda issued by CMS, from information provided on the CMS website, from information provided by the Workers Compensation Review Contractor (WCRC), and from the CMS WCMSA Operating Rules. The intent of this reference guide is to consolidate and supplant all historical memoranda in a single point of reference. Please discontinue the reference of prior documents.

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

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Sandy Simpson

02/Aug/2024

The Centers for Medicare & Medicaid Services (CMS) has released the Self-Administration Toolkit for WCMSAs version 1.6 on August 1, 2024. The Toolkit replaces Version 1.5 which was released on May 15th.

To download the new Self-Administration Toolkit for WCMSA Version 1.6 click here.

Self-Administration with Additional Help

For injured parties who are considering self-administration, but who also want additional consultation on the process, Medivest provides a Self-Administration Kit. With purchase of the Medivest Medicare Set-Aside Self-Administration Kit, the injured person will receive a one-hour consultation on the proper administration of a Medicare Set-Aside account, covering topics including:

Where to deposit and hold Medicare Set-aside funds
Which expenses are allowed to be paid from a Medicare Set-Aside account
What rates must be used to negotiate and pay for expenses
How to annually report the Medicare Set-aside to the CMS
What to do if the MSA funds exhaust temporarily or permanently
How to discuss a Medicare set-aside with a medical provider
What are the tax implications of interest earned on Medicare Set-Aside funds

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions about self-administration, professional administration or anything else regarding rules and recommendations from CMS, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.

Older Posts

For Additional Information

MMSEA III – December 6, 2024 – NGHP User Guide Downloads 7.8

For Additional Information

Analysis

Proposed MSAs and Total Settlement Amounts

Medical vs Rx

Take Aways

Proposed vs Recommended

The Big Question

For Additional Information

MMSEA III – October 7, 2024 – NGHP User Guide Downloads 7.7

For Additional Information

A New NGHP Webpage for Civil Money Penalties

Expanding Reporting Requirements

A Reminder of the Expanded Data Reporting Fields

What Does All of This Mean?

Why Choose Medivest Asure for Professional Administration

For Additional Information

Mandatory Reporting for Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers’ Compensation

Mandatory Reporting for Liability Insurance (including Self-Insurance), No-Fault Insurance and Workers’ Compensation

Medivest’s Asure Pro-Admin Helps Protect All Parties

Asure Pro-Admin: Professional Administration for MSA Accounts by the professionals

Self-Asure: The DIY solution with Medivest’s expert support

4 Asure: Easy approach to navigate settlement compliance for Insurer, Self-insured, and TPA without adding ANY work to the adjuster’s already full plate. The streamline process of:

Summary/Takeaways

MMSEA Section 111 Mandatory Insurer Reporting (NGHP)

Self-Administration Toolkit, Version 1.6

WCMSA Reference Guide, Version 4.3

For Additional Information

Changes in Version 4.1 of this Guide Include the Following Changes

For Additional Information

Self-Administration with Additional Help

For Additional Information

Recent Posts

**Medivest’s Asure Pro-Admin Helps Protect All Parties**

Asure Pro-Admin:
Professional Administration for MSA Accounts by the professionals

Self-Asure:
The DIY solution with Medivest’s expert support

4 Asure:
Easy approach to navigate settlement compliance for Insurer, Self-insured, and TPA without adding ANY work to the adjuster’s already full plate. The streamline process of: