On April 15, 2026, The Center for Medicare & Medicaid Services (CMS) held their long anticipated webinar,  focusing on mandatory WCMSA reporting.  This comes on the heels of their release of a series of updated policy guides, most notably a new NGHP Section 111 User Guide. Upon the of release of which, ECS’ own Marty Cassavoy Esq. issued a blog post highlighting the key updates, including mandatory WCMSA reporting for claims with multiple dates of loss and/or payers. Marty’s explanation was in lockstep with the information highlighted in CMS’ webinar.

Here are several noteworthy items discussed:

1.    The Why

After taking us through a standard background of the MSP, CMS gave us the “why” behind adding WCMSA data to Section 111 reporting.  Historically, CMS had incomplete data on MSAs because not all WCMSAs were submitted for approval through the voluntary submission process, CMS acknowledged the increase in Evidence-Based MSAs and Non-Submit MSAs as two situations.  The result in their eyes was that CMS risked paying when it should not pay.  
Why is this important for our industry? WCMSA data being included in TPOC reporting assumes proper coordination of benefits. CMS thereby creates a record to deny future Medicare payments tied to injury and notifies the beneficiary about MSA usage and exhaustion rules.

2.    The When

Where settlement has been finalized, a WCMSA determination is incorporated into the total settlement amount, and the TPOC date is on or after April 4, 2025, RREs are expected to report all data.  CMS clarified that WCMSA reporting does not alter their direction to only report after there has been a TPOC settlement, judgement, award, or other payment and/or after ORM has been assumed.  CMS also reiterated that enforcement of Civil Money Penalties will be limited to TPOC dates after 8/1/2025.

3.    Is the Inclusion of a Professional Administration EIN Required?

While both the Case Control Number and Professional Administration EIN are optional fields, CMS noted that these optional fields can still cause system errors if inaccurately omitted.  While not required, a professional administrator exists and you do not report it, CMS will assume self-administration, which incorrectly shifts responsibility to claimant.
Further, leaving the Case Control Number blank will cause CMS to assume there is no evidence of a corresponding voluntary WCMSA proposal submitted to CMS prior to the RRE’s report.

4.    WCMSA Review / Submissions Preemptively Completed

Beware - premature TPOC reporting can lead to issues with CMS review and approval.  If you report before the WCRC has finalized its review of MSA submission, CMS will presume the claim has settled and will then essentially kill the voluntary MSA review process. Thus, it is critical to report TPOC and WCMSA data only after the claim has fully settled.  

5.    Value Tolerance

A big issue for CMS occurred when there was a mismatch between a CMS-approved WCMSA and the reported WCMSA amount.  Even small differences (like cents or rounding) caused system confusion and incorrect case handling.  Previously, CMS converted these to non-approved, identified them in their system as complete and sent a notice of settlement letter.  CMS addressed these issues by not including cents and adding “value tolerance” to account for numbers that were relatively close.  CMS noted that RREs must confirm their data and check field requirements before reporting.
Of note, Angel Pagan stated that if WCMSA data is left out of reporting or if the amount is incorrect, the RRE can correct the WCMSA field by recording an update transaction with the corrected data.

What matters for you is the following:

1.    Do not report until you receive a response on your voluntary CMS submission and the settlement is finalized.

2.    Avoid sloppiness.  Match the WCMSA data to your CMS approved amount.

3.    Treat the optional fields as required, when applicable 

4.    Confirm administration type and funding type 

5.    If there is confusion surrounding reporting of multiple DOIs or RREs, reading Marty’s blog will help tremendously!

ExamWorks Compliance Solutions continuously monitors regulatory and legislative developments in the Medicare Secondary Payer space. For further information about this or if you have any questions, contact Lou Porrazzo, Esq. at (781) 589-9393 or Louis.Porrazzo@examworkscompliance.com.