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New Medicare set-aside rules could impact workers compensation

Posted On: Jul. 29, 2012 12:00 AM CST

New Medicare set-aside rules could impact workers compensation

While the Centers for Medicare and Medicaid Services is considering whether to issue new rules for Medicare set-asides in liability claims, experts say the agency's recent memo also could affect workers compensation settlements.

CMS has a “formal, yet voluntary” approval process for Medicare set-asides used to pay future medical costs for Medicare beneficiaries who settle workers comp claims.

Some service providers who specialize in Medicare compliance for workers comp cases have forgone the optional process in order to reduce time and costs associated with closing those claims, said Martin Cassavoy, vp of strategic services for North Reading, Mass.-based Crowe Paradis Services Corp., a Medicare secondary payer compliance company.

However, an advance notice of proposed rulemaking issued by CMS last month contains wording that Mr. Cassavoy thinks could be used to make the set-aside approval process mandatory for workers comp.

“There's a strong likelihood that the current process surrounding workers compensation, if it doesn't change, at least gains some teeth,” he said.

Dan Marshall, managing director for risk control and claims at Aon Global Risk Consulting in Charlotte, N.C., said CMS could be considering whether to expand the set-aside approval process already in place for workers comp.

“I think it's going to increase the scrutiny on the dollar figures and the estimated future medical spend as it relates to workers comp,” he said of the rules in the recent advance notice.