On June 17, 2025, the Centers for Medicare & Medicaid Services (CMS) hosted an educational webinar titled “Introduction to Workers’ Compensation Medicare Set-Asides (WCMSAs).” In what essentially boiled down to MSA 101, the webinar covered the basics of when a WCMSA is appropriate, CMS submission, funding / administration, and the re-review process. It concluded with a brief Question and Answer segment.

When discussing how WCMSAs fit into the “big picture” of Medicare Secondary Payer (MSP) compliance, CMS was quick to point out that insurers are required to report all situations where they are actively paying for care or have made a payment that releases medicals. This statement undoubtedly served as a timely reinforcement of the mandatory WCMSA reporting requirements, which took effect on April 4, 2025.

Below are some key takeaways from yesterday’s webinar:

CMS Submission

• Policy Change Effective July 17, 2025: CMS will no longer review WCMSAs proposals with a zero-dollar allocation. This change was featured in an ECS blog article last month – read it here.
  
  
• Submission Turnaround Times: CMS reiterated that its standard submission review and approval timeframe remains approximately 45 to 60 days. CMS also discouraged submitting parties from contacting the Workers’ Compensation Review Center (WCRC) for a status update prior to 45 days post-submission.

• Voluntary Submission: CMS emphasized that there are no statuary regulations requiring WCMSA submission to Medicare for review. That said, CMS then indicated that voluntary submission “guarantees” Medicare will resume payment upon appropriate exhaustion of WCMSA funds.

Non-Submit MSAs

• CMS reaffirmed its neutral stance on non-CMS-approved WCMSAs. It was stated that while Medicare will use the information from these types of set-asides to coordinate benefits, participation in Medicare’s review process affords the beneficiary “certain additional protections.”

Mandatory WCMSA Reporting

• New “Notice of Settlement” Letters: For reported claims, CMS will now issue letters confirming that it has received information regarding a WCMSA relating to a workers’ compensation claim. CMS advised that reporting parties should take measures to proactively inform claimants of the WCMSA’s existence and amount before these letters are distributed.

Question and Answer

• CMS Development Letters: A recurring issue was raised during the Q&A segment of the webinar regarding development letters. Specifically, a noted increase in requests for medical records covering the last two (2) years of treatment – even in cases where treatment concluded several years ago and the parties are now seeking CMS review and approval. CMS clarified that if the last two years of treatment do not fall within the most recent two calendar years, and there is an indication of future treatment (e.g. recommended follow-up visits), additional medical records will be requested.

While the webinar highlighted several recent changes surrounding WCMSAs, it also served as a reiteration of CMS’ long-standing positions. CMS’ voluntary review and approval process remains the gold standard to avoid an assumption of payment burden shifting. Although, given the transparency now provided with the newly established WCMSA reporting requirements, there was an expectation of a higher level of acceptance for claims involving Medicare beneficiaries. Additionally, there is no jumping from the hamster wheel of development anytime soon. If parties think that a drop off in treatment and a payment history to match will pass muster for CMS review and approval, think again. To avoid submission delays, parties should ensure a signed statement from a treating physician is provided that clearly indicates the last date of treatment.

Our expert team at ECS continues to closely monitor CMS trends and is here to support you in meeting your Medicare Secondary Payer (MSP) compliance obligations while also achieving the best claims outcomes. Should you have any questions, contact your local or national account manager or Neha Pellegrino at neha.pellegrino@examworkscompliance.com