CMS Approves Backlog of Older WC-MSA Proposals

By Sidney Wong January 25, 2013

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.


Sidney Wong

Sidney Wong is the assistant vice president of policy at ISO Claims Partners, where he provides the highest level of client services—with a focus on meeting the needs of clients through ISO’s products and services. He is also responsible for assisting clients with effectively navigating Medicare compliance issues.