Medicare and Workers' Compensation: Key Information to Understand
Understanding the ins and outs of reporting workers' compensation settlements to Medicare is crucial, especially with new regulations taking effect on April 4, 2025. Here's a breakdown of what you need to know:
The Lowdown on Reporting
- Medicare Set-Aside (MSA) Reporting: All full and final settlements, regardless of the settlement amount, now require MSA reporting. This includes providing details such as the settlement amount, MSA allocation, and funding mechanisms via the Section 111 reporting process.
- Section 111 Reporting: This process involves submitting detailed info, including ICD-9 and ICD-10 codes, accident descriptions, and personal identifying information, to the Department of Health and Human Services, helping Medicare keep tabs on future medical care.
- Thresholds: Previously, there were informal thresholds, but now, reporting is necessary for all Medicare beneficiaries, no matter the settlement amount. Even settlements below $25,000 or $250,000 must be reported if they involve Medicare beneficiaries.
- Compliance and Penalties: Neglecting to comply can lead to hefty daily fines of up to $1,000 per day per claim and potential denial of future Medicare benefits for the injured worker.
- Medicare Secondary Payer (MSP) Compliance: Ensuring MSP regulations are followed is crucial to protect Medicare's interests and avoid future liability for employers and insurance carriers.
Steps to Compliance
- Process Revamp: Review and update internal procedures for handling WCMSA settlements.
- Training: Provide training for claims adjusters and legal teams on new CMS updates.
- Legal and MSP Compliance: Collaborate with legal counsel and MSP compliance teams to guarantee all requirements are met.
In essence, the reporting process is designed to ensure Medicare's interests are safeguarded in all settlements involving Medicare beneficiaries, irrespective of the settlement amount.
- Uncategorized: It is essential to comprehend that, moving forward, all Medicare set-aside (MSA) reporting, regardless of the settlement amount, falls under the Section 111 reporting process, which includes details like ICD-9 and ICD-10 codes, accident descriptions, and personal identifying information.
- Healthsystems: Adherence to Medicare Secondary Payer (MSP) regulations is crucial for healthsystems to protect Medicare's interests and avoid future liability for employers and insurance carriers.
- Health-and-wellness: Neglecting to comply with the reporting regulations can lead to daily fines of up to $1,000 per day per claim and potential denial of future Medicare benefits for the injured worker, emphasizing the importance of health-and-wellness in the long run.
- Nutrition and therapies-and-treatments: The reporting process is designed to ensure that Medicare's interests are safeguarded in all settlements involving Medicare beneficiaries, irrespective of the settlement amount, which may include nutrition, therapies, and treatments in the future.
