CMS Medicare Set-aside Review Updates

The current CMS review timeline is estimated between three and four weeks. If CMS does not receive all the necessary documentation in order to complete its review at the time of the initial submission, however, the review time could be much longer. In order to ensure that CMS completes its review in a timely manner, it is important to provide all documentation that CMS requires at the time of the initial submission. To review an MSA proposal, CMS will require a First Report of Injury, claims payment history showing at least all medical payments for the last two years, pharmacy documentation, and medical records for the last two years of treatment, no matter how long ago those last two years were, who paid for the services, or if the claim has been completely denied. Special circumstances may require additional documentation, such as primary care records, an all-inclusive claims payment history, or a personal pharmacy listing, however, we will always alert you to those possibilities at the time that the report is prepared. Gathering the documents required by CMS, along with any supplemental documentation noted when the report is prepared, prior to submission, could save significant time and money in the review process.