Is CMS Still Approving Zero Waiver MSAs?

by D. Dietz

For our final knowledge series webinar on Medicare Secondary Payer Compliance, we discussed whether CMS is still approving Zero Waiver MSAs as well as Medical Zero MSAs. The short answer is, yes. CMS is still approving Zero Waiver MSAs.

In this webinar, we discussed the documents CMS requires to review and approve Zero Waiver MSAs. We also discussed the specific criteria in which a medical Zero MSA can be completed: cases wherein the treating doctor is stating the claimant is released from care with no future treatment needed, and no permanency rating assigned.

Pursuant to Section 4.2 of the Worker’s Compensation Medicare Set-Aside (WCMSA) Reference Guide, a WCMSA is not necessary under the following conditions because when all three are true, they indicate that Medicare’s interests are already protected:

1. The facts of the case demonstrate that the injured individual is only being compensated for past medical expenses (i.e., for services furnished prior to the settlement);
2. There is no evidence that the individual is attempting to maximize the other aspects of the settlement (e.g., the lost wages and disability portions of the settlement) to Medicare’s detriment; AND
3. The individual’s treating physicians conclude (in writing) that to a reasonable degree of medical certainty the individual will no longer require any Medicare-covered treatments related to the WC injury.

If you would like a link to the recorded webinar, have any questions, or wish to discuss how the IMPAXX team can review your options for future medical settlement and work with you to achieve an optimal outcome for final case resolution, please contact us at [email protected].