Recent CMS Comment on Zero Allocation Medicare Set Aside Submissions

Recently CMS provided additional clarification regarding what it will and won’t consider in relation to requested approval of zero sum allocations and the review processes related to the same for Medicare Set Asides.

Previously, there has been some discussion/efforts by CMS that prior to approval for zero sum Medicare Set Aside allocation requests, the parties must obtain an “on the merits” determination from the relevant adjudicating body as related to the workers’ compensation claim. From a workers’ compensation practitioner’s stand point, that would be extremely difficult and likely unworkable.

However, as of now it appears that the basic requirements to obtain a zero sum allocations from CMS are that no payments have been made by the employer/insurer and the claim had been denied as related to compensability. However, we would caution that these are not “guarantees” but the basic threshold requirements for submission of a zero sum allocation request.

For questions regarding the applicability of Medicare set asides in Nebraska or Iowa Workers’ Compensation matters, please don’t hesitate to contact Baylor Evnen Workers’ Compensation attorneys, Paul Barta or Dallas Jones at 402.475.1075.