Unpacking the New CMS Guidelines on Workers’ Compensation MSA Reporting: Insights from the Latest Q&A Webinar
Written by: Neha Pellegrino, Esq., MSPA
Yesterday, the Centers for Medicare & Medicaid Services (CMS) hosted a Question and Answer webinar regarding the expansion of Section 111 Total Payment Obligation to Claimant (TPOC) reporting to include Workers’ Compensation Medicare Set-Aside (WCMSA) information. In February of this year, CMS published a technical alert confirming that such reporting will become mandatory for Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) on April 4, 2025.
Here are a few takeaways from yesterday’s Q&A session:
1. Although the WCMSA reporting implementation date is currently earmarked for April 4, 2025, CMS will not assess any Civil Money Penalties (CMPs) associated with improper WCMSA reporting for two reporting periods (or 6 months) after the April 4, 2025 implementation date. This suspension period derives from the Final Rule’s temporary deferment of CMPs where RREs are required to make significant changes to their systems to prepare data for Section 111 Medicare reporting purposes.
· CMS indicated that the suspension of CMPs could arise again as CMS continues to update its policies and procedures surrounding WCMSA reporting. More specifically, CMPs would be suspended for two reporting periods so long as the CMS update caused the non-compliance in reporting.
· In the same vein, CMS addressed how different types of errors in reporting could impact the imposition of CMPs. For example, when a “hard error” occurs, CMPs could apply if the hard error remains uncorrected because while a report was made, the information would be rejected by CMS. However, on the other hand, a “soft error” would likely not result in CMPs because the information would still be accepted and thus reported timely.
2. For settlements that involve both a workers’ compensation claim and a third-party liability claim, where the liability claim releases the workers’ compensation carrier from future medical expenses, the workers’ compensation carrier must report the WCMSA information to CMS. This detail is notable as it indicates that the upcoming WCMSA reporting requirement is not solely reserved for workers’ compensation settlements.
Once again, CMS confirmed that the purpose of collecting WCMSA information is to improve the collection and coordination of Medicare beneficiary benefits. Thus, this new MSA reporting requirement is not a direct result of the proliferation of non-submitted, evidence-based Medicare Set-Asides. NGHP RREs will be required to report WCMSA information for all workers’ compensation settlements involving Medicare beneficiaries, regardless of the total settlement amount, whether the Medicare Set-Aside was voluntarily submitted and reviewed by CMS, or whether the Medicare Set-Aside was a non-submit / evidence-based allocation.
Sanderson Firm Commentary
Yesterday’s Q&A session by CMS assisted in explaining any remaining questions from CMS’ previous webinar held just last week on April 17, 2024. As always, we appreciate that CMS continues to provide valuable details surrounding the WCMSA reporting process.
Again, the upcoming WCMSA reporting requirement does not become effective until April 4, 2025. However, WCMSA testing will begin on October 7, 2024. We strongly encourage NGHP RREs to take advantage of the WCMSA testing period. Sanderson Firm’s reporting solution, SandersonComply, has already been configured for proper reporting of WCMSA information and is available for all NGHP RREs. If you or your organization have technical concerns or questions about the upcoming WCMSA reporting requirement or would like to learn more about how Sanderson Firm’s Section 111 reporting solution will benefit your organization, please contact us.
