MSAs in Denied Workers' Compensation Claims: Fact Vs Fiction

Have a denied claim and need more information about how to handle the MSA issue? The article below provides a detailed fact versus fiction about WCMSAs in denied workers' compensation claims. Here are the highlights:

  • FACT: Medicare's recovery rights under the Medicare Secondary Payer (MSP) Act are not automatic.
  • FICTION: The MSP Act requires MSAs.
  • FACT: An MSA might be appropriate for anyone, not just current Medicare beneficiaries.
  • FICTION: When future medical expenses are expected to be incurred, an MSA must be funded.
  • FACT: A denied workers' comp claim represents a compromise situation as opposed to a commutation under the federal regulations.
  • FICTION: The CMS WCMSA Reference Guide is the only place to look for how CMS handles future medical expenses.
  • FACT: The regulations, like the law itself, do not address MSAs.
  • FICTION: The regulations address future medicals for commutation cases exactly how they address future medicals for compromise cases.
  • FACT: Submitting MSAs is a voluntary process.
  • FICTION: CMS workload review thresholds provide safe harbors for those cases failing to meet threshold.
  • FACT: CMS is willing to review a $0 MSA proposal.
  • FICTION: It takes CMS the same amount of time to review a $0 MSA proposal as it does any other MSA proposal.
  • FACT: Once you've voluntarily asked CMS to review your $0 MSA, you've agreed to play by CMS' own rules.
  • FICTION: The MSP Act always preempts state law with respect to future medical expenses.
  • FACT: Medicare is not a party to the workers' comp claim; instead, it's the most important potential "lienholder" to consider when resolving the workers' comp claim.
  • FICTION: MSA vendors who only review medical records when calculating MSAs provide accurate conclusions that align with the legal requirements of the MSP Act.
  • FACT: Instead of asking CMS to review and approve a $0 MSA allocation (when thresholds are met), consider obtaining a legal opinion from a lawyer experienced in the MSP Act.