CMS Releases WCMSA 2023 Fiscal Year Statistics

by B. Smith

The Centers for Medicare & Medicaid Services (CMS) released the fiscal year statistics (2020 to 2023) for Workers Compensation Medicare Set-Asides (WCMSAs) submitted to CMS as part of the voluntary review process. The report can be found in the Downloads section of the Reports page on CMS.gov.

Table 1: WCMSA Proposed Values, evidences a slight increase in the number of WCMSAs submitted to CMS for review in 2023. At a recent industry conference, CMS representatives commented on this change noting that they could not attribute it to a single factor. Of note in Table 2: WCRC Values is the increase in recommended changes CMS made to submitted WCMSA amounts. In 2022, CMS increased proposed allocations by 14.11%. In 2023, this increased significantly to 21.95%, representing a 7% jump from last year.

Although the fiscal year statistics provide limited data elements for review, they illustrate some of the frustration that can occur with counters from CMS, a trend that does not appear to be dissipating. It further illustrates why some organizations choose a non-submit, or certified program, to avoid WCMSA overfunding while reasonably considering Medicare’s interest. If submission to CMS is chosen by the parties, all potential mitigation options should be identified and pursued prior to submission to help avoid increased allocations.

Selecting a Medicare compliance partner who can assist you in identifying the program approach that is right for you is the best way to ensure consistency, compliance, and cost containment in the Medicare Secondary Payer process. For more information about a total program approach to Medicare compliance, or should you have questions regarding the above, please contact the IMPAXX Settlement Consulting team at [email protected].