Keep current with new legislation and its potential effect on your organization. This regulatory update is for informational purposes only, and provides some key highlights on state initiatives that may impact the Medicare Set-Aside services Genex provides.
From time to time CMS will release updates to their Workers’ Compensation Medicare Set-Aside (WCMSA) Reference Guide (the Guide). On October 1, 2018 CMS released their latest update, Version 2.8.
Version 2.8 of the Guide includes the following updates:
I. Information about the discontinuance of all Social Security Number (SSN)-based Medicare identifiers
You may recall that earlier this year CMS began an initiative to issue New Medicare cards containing an 11-byte Medicare Beneficiary Identifier (MBI)-based card to each Medicare beneficiary by April 2019. As required by Section 501 of the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015, CMS must discontinue all Social Security Number (SSN)-based Medicare identifiers. CMS database fields formerly labeled as “HICN” have been relabeled as “Medicare ID” and can accept either a HICN or the new MBI
One significant note is that CMS has indicated that when contacting the BCRC to report a new WC occurrence by phone or by mail they will accept the Injured person's Medicare ID which can be reported as either the Health Insurance Claim Number [HICN], Medicare Beneficiary Identifier [MBI]) or Social Security Number (SSN).
II. Updates to the link for the CDC Life Expectancy Table (See Section 10.3). The current link to the Life Expectancy table used by CMS can be found here United States Life Tables, 2014
III. Updates to methods for Verifying Jurisdiction and Calculation for medical reviews (Table 9-1 and Table 9-2)
In the prior version of the Guide information pertaining to jurisdiction verification and calculation methods could be found in a short diagram labeled Figure 9.3. The updated Guide breaks down the calculation methods and jurisdiction into two separate tables, providing the order of precedence for jurisdiction and pricing. Table 9-1 provides the verification, jurisdiction and calculation methods for “Normal Pricing”. While Table 9-2 provides the verification, jurisdiction and calculation methods for “Other Pricing” such as claims involving US Labor Office Workers’ Compensation programs, Longshore Harbor Workers’ Compensation Act and states that have no WC fee schedule. The enhanced tables provide a comprehensive breakdown of when to use Normal Pricing versus Other Pricing utilizing numerous IF/THEN examples.
To view the WCMSA Reference Guide in its entirety please click here: WCMSA-Reference-Guide-Version 2.8
For more information/questions about the updated to version 2.8 of the Guide or to make a referral please contact Genex MSA at 1.888.GO.GENEX or msadirect@genexservices.com
