CMS Releases New Re-Review Option for WCMSAs

On July 10, 2017, CMS issued an updated Workers’ Compensation Medicare Set-aside Portal (WCMSAP) User Guide which includes an expanded re-review process. The re-review process now allows for an Amended Review of cases where projected care has changed so much that a previously approved MSA amount will change by at least 10% or $10,000 (whichever is greater). The new proposed MSA amount can be greater or less than the previously approved MSA amount as long as the difference is at least 10% or $10,000.

This new Amended Review option is limited. It is only available in cases originally submitted between 1 and 4 years from the current date. It requires that new medical and/or prescription drug details be included and supporting documentation be provided. Additionally, a change from brand-name to generic drugs can not be the sole reason for the re-review request; there must be an additional change (such as changes in dosage or frequency, additional drugs, or drugs discontinued) to qualify for a re-review request. Importantly, only one Amended Review is available per case, even if the Amended Review is denied.

This is a welcome and positive change that we have been anxiously awaiting. With the opportunity to obtain a reduced MSA due to changes in treatment, clients may be able to settle cases that could not previously settle because the MSA was too high.

#WorkersCompensation #Medicare #MedicareSetaside #MSA #AmendedReview #CMSAlert #CMS

Recent Posts

© 2020 Carr Allison Medicare Compliance Group

100 Vestavia Parkway

Birmingham, AL 35216

P: 205.949.2949

F: 205.822.2057



  • LinkedIn - White Circle
  • Twitter - White Circle


Required statement from the AL State Bar:  No representation is made that the quality of legal services to be performed is greater than the quality of legal services provided by other lawyers.  Any recoveries and testimonials are not an indication of future results. Every case is different, and regardless of what friends, family, or other individuals may say about what a case is worth, each case must be evaluated on its own facts and circumstances as they apply to the law. The valuation of a case depends on the facts, the injuries, the jurisdiction, the venue, the witnesses, the parties, and the testimony, among other factors.  Disclaimer.