MSA Tip — Avoid Troublesome Issues with Work Comp MSA Submissions

MARCH 15, 2021

MSA Source works closely with its partners to ensure the workers’ compensation Medicare Set-aside (MSA) experience is positive and reaches the best results.  This includes the following efforts:

• A close review of all documents provided to ensure there are no missing items early in the process;

• Understanding of evidence-based treatment protocols to and CMS guidelines to each the lowest legally defensible amount when submitted the MSA for review and approval; and

• Offer suggestions on submission requests to may be problematic to avoid unexpected delays in the submission process.

MSA Source offers the following suggestions to members of the claim management team when submitted a Medicare Set-aside:

• Outline the specific dates of injury and whether those injuries are admitted and denied.  If there are multiple body parts, be sure to itemize each injury and state whether it is compensable;

• Provide a complete set of medical records.  The internal review team will review all medical records submitted and determine what records are required for submission and what are not accepted.  CMS generally does not review IME reports unless it is a California workers’ compensation claim; and

• Copies of settlement documents or a letter on the insurance carrier’s letterhead outlining the terms of a settlement.  It is important to include the following:

  • Net amount paid to the employee;

  • Attorney’s fees paid to the employee’s attorney;

  • Attorney’s cost/disbursements being paid;

  • Medical settlements (claimed amounts/amounts settled), including conditional payments; and

  • Claims previously settled.  This includes past medical and indemnity benefits or past settlement agreements on the same date of injury being closed out.

If submitting the settlement information on the carrier’s letterhead, it is crucial to ensure the letter is dated and signed by the responsible claim handler. 

MSA Source can also aid in obtaining the properly executed copy of the CMS Consent to Release form.  Changes were made to this Release in early 2020.  The most recent version of the form requires the employee to attest that the MSA process has been explained to them, and they are in agreement with the submission.