On November 1, 2022, for the first time in recent memory, the Centers for Medicare & Medicaid Services (CMS) made the WCMSA Fiscal Year Statistics 2020-2022 available on the Reports page on CMS.gov. The CMS Report examines patterns over the last three years in the areas of Workers’ Compensation settlements and Medicare Set-Aside (MSA) submissions.
Some of the numbers appear to have remained steady from FY 2020 through FY 2022[1]. Those include the average total settlement amount at $171, 69.53 and $71,486.37 for the average proposed MSA. In 2022, the WCRC continued to recommend a 14% higher amount (“counter higher”) in comparison to the submitted MSA.
Of note, the Report demonstrates a downward trend in MSA submissions. During the years 2020 and 2022, submissions continued to drop from 16,517 to 13,752, respectively. One of the reasons for the downturn might be a frustration due to the increased time for WCRC reviews experienced by the industry this year. Another may be a reaction to CMS’ slight relaxation of its submission stance in its update of Section 4.3 in the WCMSA Reference Guide. As ExamWorks Compliance Solutions reported in our March 21, 2022 Blog, CMS re-stated that settling parties who decide not to submit their MSAs may avoid adverse consequences if they can show “both the initial funding of the MSA was sufficient, and utilization of MSA funds was appropriate.” Whatever the reason may be, it is clear that less settling parties chose to elect CMS’ voluntary submission process in FY 2022.
ExamWorks Compliance Solutions continuously monitors regulatory and legislative developments in the Medicare Secondary Payer space. For further information about this Report or if you have any questions, contact Patricia Strang at 678-256-5048.
Patricia Strang, Esq. is MSP Compliance Counsel with ECS. A registered nurse for more than twenty years, Patricia graduated with a nursing degree from St. Petersburg College and a legal degree from Stetson College of Law. Patricia is a registered nurse and an attorney licensed to practice law in the State of Florida, in addition to retaining MSCC and CMSP certifications. Patricia may be contacted at patricia.strang@examworkscompliance.com or 678-256-5048.
[1]The U.S. government’s fiscal year runs from July 1st through June 30th.