- WCMSA Top Submission Errors and Helpful Hints
Last Updated 03/19/2018
- CDC’s 2018 Life Table
Beginning March 27, 2021 CMS will begin referencing CDC’s “Table 1: Life Table for the total population: United States, 2018” for the Workers’ Compensation Medicare Set Aside life expectancy calculations.
- Workers Compensation Medicare Set-aside Arrangements (WCMSAs) Reference Guide
Revised October 4, 2021, COBR-Q4-2021-v3.4
- Inclusion of benzodiazepines and barbiturates starting 06.01.2013
On October 2, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum to Part D Sponsors concerning the transition to Part D Coverage of Benzodiazepines and Barbiturates beginning in 2013. Effective June 1, 2013, all Workers’ Compensation Medicare Set-Aside (WCMSA) proposals submitted to CMS for a review of the adequacy of the proposal amount are to include the pricing of benzodiazepines and barbiturates, where appropriate. Please note that WCMSA cases submitted to CMS before June 1, 2013, closed due to missing, incomplete and/or inadequate supporting documentation (or any other reason), and subsequently re-opened after June 1, 2013, will also be subject to a review that includes the pricing of benzodiazepines and barbiturates.
- Decision Memo for Acupuncture for Chronic Low Back Pain
CMS will cover acupuncture for chronic low back pain, with up to 12 visits in 90 days for Medicare beneficiaries under certain circumstances.
- Decision Memo for Transcutaneous Electrical Nerve Stimulation for Chronic Low Back Pain (CAG-00429N)
TENS is not reasonable and necessary for the treatment of CLBP under section 1862(a)(1)(A) of the Social Security Act.
- Medicare Secondary Payer Fact Sheet for Provider, Physician, and Other Supplier Billing Staff
The purpose of this fact sheet is to provide a general overview of the MSP provisions for individuals involved in the admission and billing procedures for health care providers, physicians, and other suppliers.
- Medicare Secondary Payment Subrogation Rights
The purpose of this memorandum is to summarize and convey support for regulations giving Medicare Advantage organizations (MAOs) and Prescription Drug Plan (PDP) sponsors the right, under existing Federal law, to collect for services for which Medicare is not the primary payer.
- CMS Revised Timeline for TPOC 09.30.2011
Revised Implementation Timeline for Certain Liability Insurance (Including Self-Insurance) Total Payment Obligation to the Claimant (TPOC) Settlements, Judgments, Awards or Other Payments
- CMS Memorandum 09.29.2011
The purpose of this memorandum is to provide information regarding proposed Liability Medicare Set-Aside Arrangement (LMSA) amounts related to liability insurance (including self-insurance) settlements, judgments, awards, or other payments (“settlements”).
- CMS Texas Regional Handout 05.25.2011
Memo from the CMS’ Texas Regional office on Liability MSAs
- CMS Memorandum 05.11.2011
The purpose of this memorandum is to reiterate guidance provided in the Centers for Medicare & Medicaid Services’ (CMS’) July 23, 2001, July 11, 2005, and April 25, 2006 procedure memoranda regarding CMS’ Workers’ Compensation Medicare Set-aside Agreement (WCMSA) proposal review thresholds, which can be found on CMS’ Web site at: https://www.cms.gov/WorkersCompAgencyServices
- CMS Revised Timeline for TPOC 11.09.2010
Revised Implementation Timeline for TPOC Liability Insurance (Including Self-Insurance) Settlements, Judgments, Awards or Other Payments II. Extension of Current Dollar Thresholds for Liability Insurance (Including Self-Insurance) and Workers’ Compensation