CMS Removes Six Year Limitation on Amended Reviews

We wanted to bring to your attention a recent update from the Centers for Medicare & Medicaid Services (CMS) that may have a positive impact on your pending cases. CMS has made a significant change in the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (Version 3.9, updated May 15, 2023) regarding the eligibility criteria for Amended Reviews that may allow you to settle claims that you were previously unable to settle due to a high WCMSA.

Previously, there was a six-year limitation on Amended Reviews, but CMS has now removed this limitation. This means that cases where CMS issued an approved Medicare Set-Aside (MSA) amount more than six years ago can now be re-evaluated. If you have encountered challenges settling cases due to disputed MSA determination amounts, treatment issues, or other settlement factors, this update opens up new possibilities for resolution.

We are ready to assist you in reviewing claims where CMS has previously issued a determination, but the claim remains unsettled. We can help determine if an amended review is now feasible, potentially leading to a revised CMS approval that allows for settlement of the claim.

Please take advantage of this opportunity by reaching out to us for a review of your claims. Our goal is to provide the support and guidance needed to help you navigate the evolving landscape of CMS regulations.

If you have any questions or concerns regarding the recent update in the CMS WCMSA Reference Guide or any other matters related to Medicare Secondary Payer (MSP) compliance, please don’t hesitate to contact our partners Dan BowersJoe DeCoursey, or Nicole Graci. We are here to assist you with the Amended Review process and provide the information you need to make informed decisions. We trust that our MSP expertise will assist you in getting your claims settled. 

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