The Deadline for Section 111 Reporting of WCMSA Amounts is Quickly Approaching
By: Gregory F. Lisowski of MSA Services, LLC
On February 23, 2024, the Centers for Medicare and Medicaid Services (CMS) announced that Section 111 reporting must now include data on Workers’ Compensation Medicare Set-Aside Arrangements (WCMSAs), effective April 4, 2025. While this change primarily affects workers’ compensation payers, who will have the obligation to report MSA amounts alongside settlement amounts under Section 111of the Medicare, Medicaid and SCHIP Extension Act of 2007, all parties involved in a workers’ compensation settlement will be impacted. Now that the deadline to report this data is quickly approaching, it is a good time to learn about the changes and how it can impact your workers’ compensation claim.
What Does This Mean for You?
CMS will now require workers’ compensation payers to report MSA amounts – even if $0 – concurrently with the Total Payment Obligation to Claimant (TPOC) for settlements on or after April 4, 2025. This new reporting requirement under Section 111, applies to both CMS-approved and non-approved MSAs and aims to enhance coordination of benefits for Medicare beneficiaries. Previously, CMS had no means of gathering information regarding the future medical component of settlements that did not fall within the CMS review threshold or where a non-submit MSA was used. This change to the Section 111 reporting allows CMS to gather and utilize data regarding the future medical portion of settlements where a Medicare beneficiary is involved, even where the claim does not fall within the CMS review thresholds. The practical result of CMS gathering this data will be to allow Medicare to deny treatment for post-settlement, injury-related medicals even where a CMS approved WCMSA was not used.
Key Points to Remember:
• The new reporting requirement is limited to Medicare beneficiaries and is prospective only, applying to TPOC dates of April 4, 2025, and later.
• Reporting is required if the insurance type is workers’ compensation and the settlement (TPOC) amount is greater than $0.
• If a WCMSA is reported, it will be considered primary for payment before Medicare.
• CMS is adding new fields to the Section 111 Claim Input File to collect this data.
• Testing of the new fields has been available to Responsible Reporting Entities (RREs) since October 7, 2024.
The Importance of Staying Informed and Prepared
These new reporting requirements have significant implications for workers’ compensation payers and TPAs. Claims systems may need to be updated, and claims professionals will require training on how to properly complete the new fields. Additionally, Claimant’s and Respondent’s counsel should be actively involved in negotiating the amount of future medical expenses that will be reported to CMS and memorializing the same in the settlement documents. Parties should also strongly consider having a defensible analysis for the future medical portion of all settlements involving a Medicare beneficiary by having an independent vendor prepare a future medical cost projection.
How MSA Services LLC, Can Help
At MSA Services LLC, we specialize in Medicare Secondary Payer Compliance and can assist you with navigating these new requirements. Our expertise includes preparing Medicare set aside allocations and future medical cost projections. Whether you are settling your claim with a CMS approved WCMSA, a non-submit MSA or simply a future medical allocation referenced in the settlement documents, we can help make sure that you are prepared for these changes and remain compliant with CMS regulations and guidance.
If you have questions about the new Section 111 WCMSA reporting requirements, don’t hesitate to reach out to MSA Services LLC. We can provide guidance and support to ensure a smooth transition and continued compliance. Visit our website at www.msaservicesllc.com or contact us today to learn more about how we can help.
Gregory F. Lisowski, JD MSCC
glisowski@msaservicesllc.com
(866) 306-9423