The Centers for Medicare and Medicaid Services is now offering to re-evaluate Medicare set-aside amounts that it has already approved in cases where medical cost projections have substantially change, a step that may allow more workers’ compensation claims to move to settlement.
CMS introduced the so-called re-review option in the latest version of its Workers’ Compensation Medicare Set-Aside Portal User Guide, dated July 10. CMS indicated late last year that it would expand its re-review process, but full details weren’t released at the time.
Re-review was previo...
Comments
Frank Neuhauser Jul 13, 2017 07:56 AM
A terrible idea. Overall, CMS loses 20%-40% on MSAs. The primary reason is that CMS, in theory, accepts the expected (average of similar cases) value to future treatment as fair. But, given high variance in actual cost, the average amount will understate the actual amount in some cases and CMS will end up paying. But when actual costs come in under expected, the other parties (insurer, plaintiff, Set-aside trust, etc.) keep the savings. CMS never profits and often losses, sometime, losing big. This revision for re-review makes the system even more unbalanced in favor of the non-CMS party. Even though CMS says "The New Proposed MSA Amount can be greater than or less than the Approved MSA Amount...(p. 12-21)" the reality is a re-review will never be submitted to CMS for a higher amount than already approved. Basically, the party or parties to the claim have two bites at the apple, shifting costs to CMS.
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