At Gallagher Bassett, we believe timely and effective communication is the cornerstone of excellence in our business to maintain trust, alignment, and confidence with our clients and partners.
Recently, the Centers for Medicare & Medicaid Services (CMS) announced updates to reporting workers' compensation (WC) requirements, which are outlined below.
Workers' Compensation Medicare Reporting — MSA Data
Effective April 4, 2025, the CMS will require additional data fields for Medicare Set-Aside (MSA) allocations in WC Total Payment Obligation to the Claimant (TPOC) reporting. This change aims to enhance CMS's visibility into WC settlements and improve benefit coordination.
When reporting TPOC for WC claims, Responsible Reporting Entities (RREs) will be also be required to report the following data points:
- MSA amount
- MSA period
- Lump sum or structured/annuity
- Initial deposit amount
- Annual deposit amount
- Case control number (optional)
- Professional administrator employer identification number (EIN) (optional)
Gallagher Bassett has been working quickly and diligently to enhance our Medicare reporting program to incorporate the new data elements and transmit the information to our reporting partners. Furthermore, we have prepared training for the resolution managers (RM) who will be responsible for entering the data to be transmitted. The result of this work will ensure our team is fully prepared to remain compliant and ready to report by this date.
Workers' Compensation MSAs Amended Review Process
Effective April 7, 2025, CMS will remove the one-year waiting period for amended review eligibility on certain WC claims. This change not only reduces the waiting time but also potentially lowers legal costs and administrative burdens associated with prolonged settlement processes on qualified claims.
WC claims may qualify if:
- CMS has issued an MSA decision and amount.
- The WC claim hasn't settled.
- The projected care has changed by at least 10% or $10,000 (whichever is greater).
To prepare for this change, Gallagher Bassett implemented a robust training program in March for all RMs who will be responsible for resolving any qualified WC claims, streamlining the review process following a CMS decision.
If you have questions, please reach out to your client services manager or contact our team.
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