On June 3, 2014, the Centers for Medicare and Medicaid Services (CMS) issued an updated Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide. The following sections of the Guide have been enhanced or added:
4.1.4 Hearing on the Merits of the Case: Section added to reflect the April 22, 2003 WCMSA RO Memorandum (Question # 5).
9.4.4 Medical Review – Step 8: Clarification of submission requirements for medical records and payment records.
10.8 Section 40 – Payment History: Updated requirements for denied conditions.
9.4.6.2 Pharmacy Guidelines and Conditions:
• Removed reference to Drug Tables for physician dispensed drugs.
• Consolidation of Drug Tapering and Drug Weaning sections.
10.5.2 Use of WC Fee Schedule vs. Actual Charges for WCMSA: Wisconsin added to list of states with no Workers’ Compensation fee schedule.
10.7 Section 35 – Medical Records:
• Removed two year requirement of medical records for unrelated to work injury.
• Clarified treating physician statements requirements.
10.8 Section 40 – Payment History- Requirements for denied conditions.
The updated Reference Guide can be found here.
