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CMS Dreaded Medicare Set-aside Arrangement Memo – Meaning?


CMS And the Dreaded Medicare Set-aside Arrangement Memo

The Dreaded Medicare set-aside arrangement memo was produced by CMS a few months ago.  Over the past week, I have covered the Centers for Medicaid/Medicare Services (CMS) Medicare Set-aside agreements and how CMS changed the playing field with its 7/1/09 memo to each state’s department of insurance. The memo should have set off a few alarm bells for the Workers Comp carriers, TPA’s, and employers.

Graphic Of dreaded medicare Hand Carrying Medical Icon

The memo switches the reporting of all Workers Comp data to CMS from voluntary to mandatory. The CMS will now be able to access almost all Workers Compensation claims data for any claim in the United States.

If the CMS’s interests have not been protected or if claims that should have been reported to them have been ignored, a very simple search and analysis software package should let them know what claims should have been reported to them, but have not as required by federal law.

What will CMS do if they find that a claim should have been reported to them for approval by way of a Medicare Set-aside Arrangement (MSA)? I think employers and carriers will receive very heavy fines. TPA’s may not be subject to the fines as the self insured employer has the ultimate financial responsibility for their claims.

Picture Dreaded Medicare Writing Arrangement Memo

How does an employer feel assured that all of their claims subject to the CMS’s thresholds have been properly handled? It may behoove an employer to contact their TPA concerning this situation. Employers may want to have a MSA expert look over their claims to make sure they are protected. From what I have seen the CMS is going to hold the employer responsible whether or not they are self insured.

There are many companies available to analyze a claim for an MSA requirement and to properly report those to the CMS. Please feel free to contact me at [email protected] if you have any further questions on this issue such as time limits, reporting thresholds, or MSA vendors.

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Is Social Security Disability Affected by WC?

Social Security Disability and Workers Comp Study Does Workers Compensation have an effect on Social Security Disability?  More precisely, do Social Security Disability applications increase

James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications


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