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WORKERS’ COMPENSATION MEDICARE SET-ASIDE ALLOCATION (WCMSA) REPORTS

Medivest recognizes the important role we play in the settlement of workers’ compensation and personal injury claims and how imperative it is to understand and assist settling parties with Medicare Secondary Payer (MSP) compliance.  A Workers’ Compensation Medicare Set-Aside Allocation (WCMSA) Report is one of the first steps taken in an effort to consider Medicare’s future interest.  Medivest has an outstanding record for providing accurate and timely WCMSA allocations that allow the settling parties to confidently proceed forward with their settlement.

What Is a WCMSA Report?

A Workers’ Compensation Medicare Set-Aside is typically required in situations involving workers’ compensation settlements for individuals who are Medicare beneficiaries or who have a reasonable expectation of becoming Medicare-eligible within 30 months of the settlement date. The purpose of a WCMSA is to ensure that funds are set aside to cover future medical expenses related to the workplace injury or illness, which would otherwise be covered by Medicare.

When a WCMSA is established, a certain amount of money is allocated from the workers’ compensation settlement specifically for future medical expenses. This amount is based on the estimated cost of the injured worker’s future medical treatment, including doctor visits, hospital stays, surgeries, medications, and other related expenses.

The funds in the WCMSA account are to be used exclusively for injury-related medical care until they are exhausted. Once the WCMSA funds are depleted, Medicare becomes the primary payer for any remaining medical expenses.

The WCMSA process typically involves a detailed review of the injured worker’s medical records, treatment history, and projected future medical needs. The goal is to determine a reasonable and adequate amount that will cover the expected medical expenses while ensuring compliance with Medicare guidelines.


When Should You Consider a WCMSA Report?

Here are some scenarios where a WCMSA may be necessary:

  1. Medicare Beneficiary: If the injured worker is already receiving Medicare benefits at the time of the workers’ compensation settlement, a WCMSA is generally required. This ensures that the settlement funds are allocated specifically for the injury-related medical expenses that Medicare would otherwise cover.
  2. Reasonable Expectation of Medicare Enrollment: If the injured worker is not currently a Medicare beneficiary but is likely to become eligible for Medicare within 30 months of the settlement, a WCMSA may be required. This situation can arise when the injured worker is 62 years and 6 months old, or when they have applied for Social Security Disability benefits.

How Long Does a Workers’ Compensation Medicare Set-Aside Take to Prepare?

Many factors influence how long a WCMSA takes to prepare and earn approval from the Centers for Medicare and Medicaid Services (CMS).

Circumstances that impact report preparation timing include:

  • Case details: More complex cases generally require additional analysis time.
  • Severity of injuries: The more serious an injury is, the longer the scope and duration of treatment to consider in the report.
  • Amount of medical records to gather: Time spent collecting and analyzing records grows with the number of treatments and providers involved.

Experienced Medicare set-aside companies like Medivest can generally create an analysis within ten business days or less.

Getting a CMS approved MSA takes about 30 to 60 days on average.

Ready to Prepare Your WCMSA?

Medivest is ready to prepare a WCMSA or LMSA for you or your client. Contact us today at 833.922.1997 or complete our contact form, and a knowledge and experienced member of our staff will contact you to discuss what information is needed to begin the report.


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