In his final post of this blog series, Rafael Gonzalez, Esq., president, Optum Settlement Solutions, looks at changes made to the Workers’ Compensation Medicare Set-Aside (WCMSA) Electronic Attestation Enhancements and what it means to Medicare Secondary Payer compliance.
The Centers for Medicare & Medicaid Services (CMS) recently announced Workers’ Compensation Medicare Set-Aside (WCMSA) Electronic Attestation Enhancements. In preparation, CMS hosted two webinars to highlight new WCMSA Electronic Attestation Enhancements. The first webinar was held on October 30 for Medicare beneficiaries and their representatives. The second webinar was held on November 6, for Professional Administrators. In anticipation of same, a revised version of the Self-Administration Toolkit for WCMSAs is now available in the Download section of the WCMSA Self-Administration page on https://www.cms.gov.
The Nov. 6 Work Comp Attestation Enhancement webinar
CMS held its Workers' Compensation Attestation Enhancement Webinar for Corporate Users and Professional Administrators on Nov. 6. During the webinar, it was explained that the purpose of the enhancement is to “add functionality to allow Professional Administrators to register accounts on the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) as well as functionality to allow Professional Administrators to submit files of account transactions and view account balance information related to WCMSA accounts for which they administer.” Doing this eliminates the need to submit information on WCMSAs via U.S. Mail; however, mailing will still be an option if preferred.
During the webinar, attendees were also informed that “in order to use the WCMSAP, Professional Administrators will be required to complete a two-step process: Registration and Account Setup. Registration will be completed by the company’s named Account Representative. This is the individual in the organization who has the legal authority to bind the organization to a contract and the terms of WCMSAP requirements and processing. The Account Representative will complete the initial step in the registration process but will not be provided with a Login ID. Account Setup will be performed by the company’s named Account Manager. The Account Manager will control the administration of the Professional Administrator account. The Account Manager can then invite Account Designees.”
After the account has been set up, the Account Manager or Account Designee can request case access for each case they have authority to administer and are required to provide the current/opening balance for all existing WCMSAs they want to administer on the WCMSAP before transaction records will be accepted for the case. “The Professional Administrator option means that a professional entity will administer and account for the WCMSA that was established to protect Medicare’s interests. When the Professional Administrator type is selected, the Professional Administrator Agreement is required and must be provided before the Professional Administrator can submit the case.”
Once registered and the account has been set up, Professional Administrators will be able to “perform a Case Lookup, Request Case Access, Upload Transaction Files and Download Response Files. This includes uploading final settlement documentation and other transactions.” The Transaction Types that can be submitted are:
1 – Beginning Balance
2 – Interest Earned
3 – Medical/RX Expense
4 – Taxes Paid on Interest
5 – Annual WCMSA Funds Exhausted
6 – WCMSA Funds Completely Exhausted
Annual Attestation for Self and Professionally Administered Medicare Set-Asides
“Every year, no later than 30 days after the anniversary date of the workers’ compensation settlement in which a WCMSA was produced by the parties, submitted and approved by CMS, the Medicare beneficiary self-administering the MSA account, or the Professional Administrator administering the MSA account, must send an attestation to Medicare’s Benefits Coordination & Recovery Center (BCRC) stating that they have used the funds in the MSA account correctly. An attestation is a signed statement, attesting to the appropriate use of the moneys warehoused in the WCMSA account.”
If you are a beneficiary administering your own MSA account, you can submit your yearly attestation online by accessing the WCMSA Portal through https://www.MyMedicare.gov. If you are a representative or Professional Administrator for the MSA account, you can log in directly to the WCMSA Portal to submit the yearly attestation. To access, go to https://www.cob.cms.hhs.gov/WCMSA/.
The Workers Compensation Medicare Set-Aside Portal User Guide
The WCMSAP User Guide, available under the Reference Materials header once you log in to the WCMSAP site, has details about submitting the attestation online. The wording on the forms is the same as found in the Self-Administration Toolkit for WCMSAs. Whether self-administered or professionally administered, the Medicare beneficiary or professional custodian can use the letter titled “Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA)—Account Expenditure for Lump-Sum” or “Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA)—Account Expenditure for Structured Account.” You must do this even if you are not yet a Medicare beneficiary, but are using MSA account funds to pay for medical care related to the workers compensation claim. The attestation should include:
- Date of treatment and name/address of medical provider
- Description of medical care/prescription medication received
- Total spent for medical services
- Total spent for prescription drugs
- Grand total of expenditures
- Total of interest income the account earned, if any
- Balance of WCMSA account at the end of the calendar year
Documenting actual spending, not necessarily amount planned for in WCMSA
When the injured worker and the employer/carrier/third-party administrator made plans for and put together the WCMSA, there was an agreement as to a specific set aside amount for future prescription medications as well as medical expenses. It is not important if what is spent from the WCMSA does not match how it was expected to be spent. For example, consider that the WCMSA is funded for $10,000, with $7,000 for prescriptions and $3,000 for medical expenses, and the injured worker spends all $10,000 for prescriptions, or spends $5,000 on prescriptions and $5,000 on medical expenses. So long as the funds were spent on medical treatment related to the workers compensation claim that were Medicare allowable at the correct rate, it will be determined that the account funds were correctly spent.
When filing the attestation form, “the requirement is to report the amounts as were actually spent. Blank attestation letters with Medicare ID (the beneficiary’s health insurance claim number [HICN] or Medicare Beneficiary Identifier [MBI]) or Social Security number (SSN) can be found as part of the WCMSA approval package that CMS provided upon submission of the MSA to Medicare for review and approval.”
Final depletion of WCMSA account funds
When the WCMSA account has no money left in it and there are no future deposits of funds expected into the MSA account, it is said to be permanently “exhausted” or “depleted.” Within 60 days of the date the account is depleted, the Medicare beneficiary if self-administered, or the custodian if professionally administered, must send the BCRC a final attestation letter and say in the letter that the account is “completely exhausted.” The attestation letters for both lump-sum and structured accounts provided in the toolkit include options for permanent account exhaustion.
“If Medicare is satisfied that the right amount of money has been spent appropriately, in other words that the Medicare beneficiary if self-administered or the custodian if professionally administered, paid only for items related to the workers compensation claim that Medicare would otherwise allow for at the correct rate, Medicare will then become the primary payer from that moment forward, paying for future treatments related to the work injury, should there be any.”
If WCMSA account funds were not spent appropriately
If Medicare is not satisfied that the WCMSA account funds were spent appropriately, Medicare may: (1) ask for proof of and an explanation of such expenditures, (2) request medical records associated with such care and treatment, (3) order reimbursement to the WCMSA account for funds inappropriately spent, (4) seek reimbursement of conditional payments paid by Medicare that should have been paid by the WCMSA account, (5) deny coverage and payment for medical care associated with the workers compensation claim, and (6) seek legal remedy, including double damages, should it be forced to file in court to recoup reimbursement of medical expenses paid by Medicare, a Medicare advantage plan, or a Medicare prescription drug plan.
Conclusion
As is true with every other component of Medicare Secondary Payer compliance, administration of workers compensation Medicare set-asides is becoming more complex.
Although the announcement of electronic enhancements to the self-administered and professionally administered WCMSA program should make it easier and faster for injured workers who self administer their accounts or Professional Administrators handling the day to day administration of such accounts, to more accurately and more efficiently report accounting and attestation on such accounts, this also means that there is now a greater sense of responsibility and accountability to the federal government on these accounts.
Make no mistake about this, it will now be easier for the federal government to keep track of these funds. In other words, expect the federal government to maintain better records and therefore be more intimately involved with these Medicare set-aside accounts and the funds warehoused within them.
RISE will explore this topic further at the Medicare Secondary Payer Master Class, Feb. 3-4, 2020, in Jacksonville, Fla.
Editor’s note: This is the final installment of a seven-part blog series. The first post focuses on the accessibility of open debts reports. The second post reviews the calculation of annual recovery thresholds for certain liability insurance, no-fault insurance, and workers’ compensation settlements, judgments, awards, or other payments. The third post reviews the changes in the Workers’ Compensation Medicare Set-Aside Arrangement Reference Guide. The fourth post deals with the extension of the Mandatory Reporting Civil Money Penalties Notice of Proposed Rulemaking to December. The fifth post examined the possible creation of federal regulations that provide options on how to take Medicare’s future interests into account. The sixth post reviews three recent cases involving attorneys representing Medicare beneficiaries in auto, liability, no-fault, and workers’ compensation claims.
About the author
Rafael Gonzalez, Esq. is president of UnitedHealth Group/Optum’s Workers Compensation and Auto No-Fault Settlement Solutions and based in Tampa, Fla. With 35 years of social insurance experience, he oversees the organization’s mandatory reporting, conditional payments, and set aside allocation process and services. He blogs on liability, no-fault, workers’ compensation, social security, and Medicare/Medicaid issues at www.MedicareInsights.com. He speaks throughout the country on these substantive issues and is engaged in the workers’ compensation, social security, and Medicare/Medicaid legislative process at both the state and federal levels. He is active on social media, including LinkedIn, Twitter, Facebook, Instagram, and YouTube. He can be reached at rafael.gonzalez1@optum.com or at 813.967.7598.