CMS quietly released a change to their re-review process earlier this week. The change was released through CMS’ Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) in the User Guide. According to MedVal, which produces a blog on Medicare Set-Aside issues, CMS has expanded the re-review process by creating an “Amended Review” option available through the portal. The new re-review process will accommodate situations in which projected care for a case has changed, such that the new proposed settlement amount differs from the CMS-approved MSA amount by 10 percent or $10,000, whichever is greater. Medical or prescription drug details must be provided to support the amended review request, with documentation. This type of review may only be submitted one time per case.
Read more about the new process here.
Access the revised WCMSAP User Guide here.