CMS Now Consistently Requesting Expense Payment Histories

Medical billing statement

by J. Mislanovich

The Centers for Medicare & Medicaid Services (CMS) WCMSA Reference Guide has always indicated that an all-inclusive payment history (including medical, indemnity, and expenses) is to be included with the submission of a WCMSA (Section 10.8: Section 40 – Payment History). However, in the past this has not been routinely enforced by CMS, unless a WCMSA included a denied claim, or there was a submission for a zero dollar/waiver of a WCMSA. CMS has now changed course and is requesting expense ledgers for all submitted cases.

Once the required documents are uploaded to the CMS portal for a submission, a claimant and their counsel may access the information and potentially see expenses related to litigation strategy (such as surveillance and investigation costs). This may in turn impede settlement or, if the case does not settle, adversely impact the claim.

While IMPAXX continues to advocate for the exclusion of this information, we are beginning to see submissions delayed due to development requests from the WCRC requesting a full expense payment history (dated within the last six months of submission). This is yet another example of the cumbersome process of submission, and the hoops that customers are often required to jump through to obtain approval of a submitted WCMSA. We will continue to monitor this trend and provide updates as they become available.

At IMPAXX, we continue to offer our evidence-based, non-submit Medicare Set-Asides as another option that reasonably considers Medicare’s interests without the delays and extra steps required for submission. If you have any questions, or would like more information regarding our non-submit MSAs, please contact the Settlement Consultant Team at [email protected].