CMS recently indicated that changes had been made to its review of MSA proposals involving denied injuries. These changes could have negatively impacted the amount required for Medicare Set-Asides involving denied injuries and greatly increased the difficulty involved in obtaining CMS approval of MSAs without funds for denied conditions.
CMS suggested that either a court ruling, following a hearing on the merits of the claim, addressing the compensability of the injuries or medical records from the treating physician, indicating that no future treatment of the denied injuries is needed on an industrial basis, would be required. It appeared that CMS would not treat a condition as denied without this documentation.
We immediately contacted CMS and challenged this unreasonable change in policy which occurred with no forewarning and could have negatively impacted our clients. CMS has now issued an alert confirming that its former policies will remain in place and any changes to its policies in the future will be published prior to taking effect. At Carr Allison Medicare Compliance Group, we're fighting for you.