WCMSA Reference Guide Version 2.0 is Released

Yesterday, CMS released the second version of its new Reference Guide for Workers’ Compensation Medicare Set-Asides (WCMSAs).  The first version,  released on March 29, 2013, was welcomed by the industry because it consolidated information from an assortment of CMS Memos and other information on their website.

Version 2.0 added 13 more pages of information, making the new reference guide 101 pages long.  It further documents the WCMSA review process used by the Workers’ Compensation Review Contractor (WCRC).

More specifically, the following sections were enhanced or added: – Most Frequent Reasons for Development Requests: The five most common omissions as provided by the WCRC.

9.4.2 – WCRC Team Background and Resources Used: The expertise of the WCRC reviewers as well as the resources used when reviewing a WCMSA.

9.4.3 – WCRC Review Considerations: Examples of the questions and factors that guide the WCRC’s review of WCMSA proposals. The overarching guidelines used in treatment allocations and pricing is also provided.

9.4.4 – Medical Review: A diagram and steps the WCRC follows in its medical review process with a general explanation of documentation requirements.

9.4.5 – Medical Review Guidelines: Considerations and examples in specific medical cases and topics. – Prescription Drug Review: Details the process the WCRC follows in reviewing prescription medication allocations and the resources that may be used. – Pharmacy Guidelines and Conditions: Discusses specific drug usage and pricing considerations. 10.1.8 – Pay history added to list of information needed for WCMSA submission.

To view the new Version 2.0 of the WCMSA Reference Guide click here.


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