Starting April 4, 2025, significant changes are coming to Section 111 reporting requirements for workers’ compensation claims involving Medicare beneficiaries. If you’re a Responsible Reporting Entity (RRE), it’s time to prepare for a broader scope of data reporting, especially when it comes to Workers’ Compensation Medicare Set-Asides (WCMSAs).

Under the new requirements, all workers’ compensation claims involving a Total Payment Obligation to the Claimant (TPOC) must now include WCMSA-related data when the injured party is a Medicare beneficiary. This applies regardless of whether the WCMSA was reviewed or approved by Medicare. CMS has updated reporting requirements published in the NGHP User Guide of the MMSEA Sections 111, which you can view the following chapters below.

• Chapter IV: Technical Information
• Chapter V: Appendices

Here is a breakdown of what needs to be reported:

1. 1. Medicare-Approved WCMSAs:
      • If your settlement includes a WCMSA that was reviewed and approved by CMS, you must report the relevant WCMSA data.
   2. WCMSAs Below the Review Threshold:
      • Even if the WCMSA wasn’t submitted for CMS review because the total settlement amount falls below the Medicare workload review threshold, the WCMSA information still needs to be reported. 
   3. Zero-Dollar WCMSAs:
      • When a settlement explicitly states that no funds are allocated for future medical care, this is considered a Zero-Dollar WCMSA. These must also be reported.
   4. Unsubmitted WCMSAs:
      • If the parties developed an MSA or allocated funds for future medical treatment but chose not to submit it to Medicare, that information must now be disclosed.

What Should You Do Now?

If you’re a claims professional, insurer, or third-party administrator, be prepared to:

• • Review your Section 111 reporting processes and confirm they can handle the new data requirements that can be found.
  • Coordinate with your WCMSA vendors to ensure you receive the necessary data for inclusion in your reporting.
  • Educate your claims team and legal partners about the upcoming changes so all parties are aligned before April 4.

Takeaways

The expanded Section 111 reporting requirements reflect CMS’s ongoing efforts to protect the Medicare Trust Funds. While they may add complexity to the reporting process, these changes also provide an opportunity for claims handlers to strengthen compliance and improve documentation practices.

For Additional Information

As always, Medivest remains committed to assisting our clients with the creation and administration of WCMSAs. Medivest will continue to monitor changes occurring at CMS and will keep our readers up to date when any new changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us at 877.725.2467.