Is CMS Still Approving Zero-Waiver MSAs?

by D. Dietz

Yes, the Centers for Medicare and Medicaid Services (CMS) is still approving Zero-Waiver Medicare Set-Asides (MSAs) on a case-by-case basis. Approval is based on documentation provided to CMS, the correct formatting of documentation, and the case specifics.

The most important factor in determining whether CMS will grant a zero waiver, is confirming that the case is truly denied, and no payments have been made for medical or indemnity benefits. If even the smallest payment has been made, CMS can deny the waiver.  CMS does consider state mandates when payments have been made, like those in California which give an employer 90 days to accept or deny a claim and payment of up to $10,000 in medical treatment. However, anything paid above or beyond the mandate will negate the zero-dollar waiver. Also, if payments were made by mistake for medical treatment, you may be able to contact the provider for reimbursement.

In addition, if payment screens show what may look like a medical payment, CMS could question it or issue a denial of the waiver and allocate. Any costs that appear to be for medical or wage loss expenditures should be explained to CMS at the time of submission.

Of course, there are other parts of a waiver submission that are important, as well as specific case factors that can come into play and need to be considered. Working with an MSA partner who is familiar with requirements and what may be a red flag and impede approval is vital to avoiding a potential allocation.

IMPAXX currently has a 96% approval rating for zero-waiver MSAs using our methodology. If you have questions about these complex submissions or would like more information about how we can help you achieve a successful outcome using our methodology, please contact the IMPAXX Settlement Consulting team at [email protected].