CMS And the Dreaded Medicare Set-aside Arrangement Memo - What Did It Mean?

Over the past week, I have covered the Centers for Medicaid/Medicare Services (CMS) Medicare Set aside agreements and how CMS changed the playing field with its 7/1/09 memo to each state's department of insurance. The memo should have set off a few alarm bells for the Workers Comp carriers, TPA's, and employers.

The memo switches the reporting of all Workers Comp data to CMS from voluntary to mandatory. The CMS will now be able to access almost all Workers Compensation claims data for any claim in the United States.

If the CMS's interests have not been protected or if claims that should have been reported to them have been ignored, a very simple search and analysis software package should let them know what claims should have been reported to them, but have not as required by federal law.

What will CMS do if they find that a claim should have been reported to them for approval by way of a Medicare Set-aside Arrangement (MSA)? I think employers and carriers will receive very heavy fines. TPA's may not be subject to the fines as the self insured employer has the ultimate financial responsibility for their claims.

How does an employer feel assured that all of their claims subject to the CMS's thresholds have been properly handled? It may behoove an employer to contact their TPA concerning this situation. Employers may want to have a MSA expert look over their claims to make sure they are protected. From what I have seen the CMS is going to hold the employer responsible whether or not they are self insured.

There are many companies available to analyze a claim for an MSA requirement and to properly report those to the CMS. Please feel free to contact me at jmoore@cutcompcosts.com if you have any further questions on this issue such as time limits, reporting thresholds, or MSA vendors.