CMS Approves Backlog of Older WC-MSA Proposals

January 25, 2013 / 1 min read

In December 2012, the Centers for Medicare and Medicaid Services (CMS) approved a substantial backlog of older Workers' Compensation Medicare Set Aside (WCMSA) proposals. Approximately 13,000 cases were pending when CMS hired a new review contractor, Provider Resources, Inc. (PRI), in July 2012.

Factors contributing to backlog

Many factors contributed to the delay. Among these factors was a substantial increase in WCMSA submissions that did not meet the CMS review criteria. In many instances, CMS delayed responding to parties’ WCMSA submissions for a year or more. The delay frustrated both primary payers, who wanted to close their files, and claimants, who wanted their settlement money.

CMS Approves Backlog of Older WCMSA Proposals

Recognizing the problem, CMS issued a statement in September indicating Medicare beneficiaries and other program stakeholders would begin to see increased CMS communications regarding the backlogged WCMSA proposals in the coming months. In December 2012, CMS finally approved the vast majority of pending WCMSA submissions. That was welcome news to workers' compensation payers and practitioners, who could at last finalize their outstanding settlements.

Workers' Compensation stakeholders

Looking ahead in 2013, many workers' compensation stakeholders will keep a close eye on the new contractor’s WCMSA review turnaround times, hoping to avoid another backlog. On a positive note, so far, many are reporting vastly improved review turnaround times from PRI.

CMS approves backlog of older WC-MSA proposals

Factors contributing to backlog

Workers' Compensation stakeholders