Tag Archives: WCMSA

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New WCMSA Reference Guide

CMS has issued an updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide, Version 3.4. The Guide has several minor changes including CMS’s focus on the receipt of appropriate settlement documents for the approval of the WCMSA.  Specifically, in Section 10.5 and in various sample letters in Appendix 5, CMS notes that “approval of the […]

CMS Amended Review

by Nancy Heidrich January 22, 2021 The Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide Version 2.6 published on July 10, 2017 introduced the CMS Amended Review as another re-review option. The Amended Review allows the parties a one-time request for re-review in the form of a new submission. To be accepted for the amended […]

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THE WHITTLING AWAY OF CMS OFF-LABEL USAGE ARGUMENTS IN THE WCMSA

With the transition to the new Workers’ Compensation Review Contractor (WCRC), the industry is seeing many changes in the Workers’ Compensation Medicare Set-Aside (WCMSA) review process. One of the biggest changes has been the shift from excluding Lyrica from the WCMSA when it is being prescribed for an off-label use to the inclusion of this […]

What’s New in the New WCMSA Reference Guide 2.8

On October 1, 2018, the Centers for Medicare and Medicaid Services (CMS) issued the latest version of the WCMSA Reference Guide, COBR-Q4-2018-v2.8.  The Guide includes updates regarding the discontinuation of Social Security numbers as  a Medicare identifier; a link to the applicable CDC Life Table; and further illustrations for determining the jurisdiction and pricing methods […]

WCMSA Submission Portal Update

CMS has finalized the testing phase of the new WCMSA Submission Portal.  CMS will be announcing a town hall meeting for Nov 29, 2011 to introduce the WCMSA Submission Portal to the general public.   An announcement will be posted on the CMS website: http://www.cms.gov/WorkersCompAgencyServices/12_WCMSAP.asp As the portal is now open for unlimited submissions for the […]