Today’s issue of WorkCompRecap features the release of a new study from Ametros that found over 34,000 claims per year were denied to Medicare beneficiaries’ post-settlement because Workers’ Compensation Medicare Set Aside (WCMSA) funds were responsible for the payments.
Ametros noted that some in the industry have questioned whether Medicare ever denies claims, it aimed to find out with the study, which examined a random sample of 5% of the Medicare beneficiary population over a three-year period. Researchers estimated Medicare denied 35,980 WCMSA claims in 2018, 36,060 in 2019, and 30,720 in 2020 because the individual’s WCMSA account should have paid the claims. The report provides a state-by-state chart of denial breakdowns along with definitions and explanations of the Medicare Secondary Payer and MSA terms, how CMS tracks MSAs, and MSA post-settlement administration and compliance obligations.