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Medicare Set Aside News - CMS Publishes "Helpful Hints" for WCMSAs

The Centers for Medicare & Medicaid Services Publishes a "Helpful Hints" Checklist for Submitting Workers Compensation Medicare Set Asides.

On May 20, 2013, the Centers for Medicare & Medicaid Services (CMS) published a "Helpful Hints" checklist for use throughout the Medicare Set Aside industry. The checklist is an important guide in 12 major areas where CMS focuses their attention when reviewing MSAs including:

  1. Incomplete or insufficient medical treatment records for the last two years of treatment.
  2. Exclusion of pertinent medical records or submitting too many records.
  3. Insufficient proof of medications, dosages, and frequencies for the last two years of treatment.
  4. Insurance Carrier or Self-Insured payments history is missing, undated, old, or incomplete.
  5. Total settlement amount missing, unclear, or improperly computed.
  6. No response or insufficient response to development requests.
  7. Proposed Medicare Set-Aside amount not clearly divided between medical services and prescription drug costs.
  8. Submission of unnecessary, unrelated, or duplicate documents.
  9. Incorrect references for a state that does not have a fee schedule.
  10. No rated age statement submitted confirming that all rated ages obtained on the claimant have been included.
  11. Incorrect pricing of drugs, for example, quoting or using prices associated with re-packagers, expected tapering, etc.
  12. Multiple dates of injury, multiple body parts, body parts remaining open for medicals.

For more information from CMS regarding their guide, please click here.

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