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Request for Re-evaluation of Medicare Set-aside Arrangements

The Centers for Medicare and Medicaid Services (CMS) has announced that it will re-evaluate an approved Medicare Set-aside Arrangement if the claimant or the submitter believes that the CMS determination (1) contains obvious mistakes, such as mathematical errors or a failure to recognize that medical records already submitted show a surgery CMS priced already has been performed or (2) misinterpreted evidence previously submitted.

The memorandum from CMS indicates that “if a WCMSA proposal amount was originally submitted via the web-portal, a re-evaluation of an approved WCMSA amount can be requested through the WCMSA web portal.” Thus, it is not clear whether CMS will accept a re-evaluation request through the web portal when the original proposal was submitted via mail. CMS also indicates that the Regional Offices will review the requests for re-evaluation submitted through the portal (rather than the contractor that made the original determination).

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