On March 20, 2009 the Centers for Medicare and Medicaid Services (CMS) notified their Medicare contractors of a new MSP code in Medicare’s Common Working File (CWF). The goal of this new code is to give the CMS the ability to better identify claims in which they should be the secondary payer due to a Workers’ Compensation Medicare set-aside arrangement (WCMSA).
The CMS’ previous process of applying a “WCSA” in the MSA Auxiliary File never insured that a conditional payment would not be made for a particular claim that should have been paid from a WCMSA. CMS believes that the introduction of this new MSA code will enable them to issue automated denials of claims and diagnosis codes that are associated with an open WCMSA. The contractors will notify the Medicare beneficiary of the denial by using the Medicare Summary Notice 29.33 which states: “Your claim has been denied by Medicare because you may have funds set aside form your settlement to pay for your future medical expenses and prescription drug treatment related to your injury(ies).”
To view this official instruction in its entirety, please click here.