In December 2012, the Centers for Medicare and Medicaid Services (CMS) approved a substantial backlog of older workers' compensation Medicare Set Aside (WC-MSA) proposals. Approximately 13,000 cases were pending when CMS hired a new review contractor, Provider Resources, Inc. (PRI), in July 2012.
Many factors contributed to the delay. Among these factors was a substantial increase in WC-MSA submissions that did not meet the CMS review criteria. In many instances, CMS delayed responding to parties’ WC-MSA 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.
Recognizing the problem, CMS issued a statement in September indicating that Medicare beneficiaries and other program stakeholders would begin to see increased CMS communications regarding the backlogged WC-MSA proposals in the coming months. In December 2012, CMS finally approved the vast majority of pending WC-MSA submissions. That was welcome news to workers' compensation payers and practitioners, who could at last finalize their outstanding settlements.
Looking ahead in 2013, many workers' compensation stakeholders will keep a close eye on the new contractor’s WC-MSA review turnaround times, hoping to avoid another backlog. On a positive note, so far, many are reporting vastly improved review turnaround times from PRI.