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