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Estimated future drug costs are the main reason that Centers for Medicare & Medicaid Services are requiring increases of Medicare set-aside amounts, according to a report from the National Council on Compensation Insurance released Monday.
According to the report, CMS usually requires larger percentage increases to Medicare set-asides when the submission amounts are smaller.
Boca Raton, Florida-based NCCI analyzed trends in the submission of Medicare set-asides to understand both the cost drivers and the medical care of workers injured on the job who are or are likely to become eligible for Medicare based on 11,500 Medicare set-asides submitted to CMS from September 2009 to December 2015.
The gap between approved and submitted Medicare set-asides was steady from 2013 to 2015 mainly due to the decrease between approved and submitted prescription drug amounts. About 64% of claimants are eligible for Medicare because they have been on Social Security disability for at least two years and another 29% of claimants are eligible due to age. Overall Medicare set-asides represent more than 40% of total submitted workers compensation settlement costs, NCCI said in the report.
“Understanding (Medicare set-asides) trends and the (CMS) review process can assist workers compensation carriers, employers, workers and other system stakeholders as they identify cost drivers,” said NCCI.
NASHVILLE, Tenn. — Uncertainty surrounds a Medicare set-aside process for liability claims that will be introduced this fall as defense attorneys try to determine how much money should be placed in those accounts.