Learning about MSAs

WCMSA Helpful Hints – Part 1 of 10

Submitting a Workers’ Compensation Medicare Set-Aside Allocation (WCMSA) is simpler in theory than in practice. Below is a common error often made when submitting a WCMSA to the Centers for Medicare & Medicaid Services (CMS), as well as some helpful hints to avoid the error. If you need more information or further help with settling claims or setting up a Medicare Set-Aside for a client, call 855.931.3003 or fill out the form.

Helpful Hint*

Always send medical records from all treating physicians for the last two years of treatment related to the work injury, even if the carrier has not paid for the treatment; even if future treatment is not allocated; and even if the treatment was long ago. Medical records for the last two years of treatment are needed, which may not be within the last two calendar years.
  • Independent Medical Evaluations (IMEs) are not treatment records, nor are invoices or insurance forms.
  • If you believe the last two years of treatment are unrelated to the work injury, send those medical records in addition to those related to the work injury, along with any necessary explanation.
  • If the claimant has not been treated by a doctor for any reason within the last two calendar years, please send a statement from a treating physician indicating when the last two years of any treatment occurred and include medical records from those last two years of treatment. A statement indicating “the claimant has not treated in the last two years” is not a substitute for medical records for the last two years of treatment.
  • Ensure that any “last treatment date” mentioned in the life care plan, carrier letter, or payment history is accompanied by a medical record matching that date. Include all medical records for the last two years prior to the “last treatment date.”

Don’t take unnecessary risks during settlement! Protect your clients’ Medicare benefits with a MSA.  To get started or even if you just have questions about a particular case you’re working on, contact Medivest at 855.931.3003 or fill out the form.


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