Once the Medicare Set-aside has been approved by CMS what is CMS subsequent role?
A22. When CMS approves a Medicare Set-aside CMS will check the National Medicare Enrollment database on a monthly basis in order to determine when an injured party actually becomes enrolled in Medicare. Once CMS verifies that the injured party has actually been enrolled in Medicare, CMS will assign a contractor, based on the injured party’s State of residence, to be responsible for monitoring the injured party’s case. When the injured party has actually been enrolled in Medicare, CMS will provide the Coordination of Benefits Contractor (COBC) with identifying information to add a workers’ compensation or liability record to their file known as a “Common Working File.” Typical information provided includes (1) injured party’s name, (2) injured party’s HICN, (3) date of incident, (4) ICD code(s) or a description of the illness/injury , (5) whether the Medicare Set-aside is self-administered or third party administered, and (6) injured party’s attorney information. The administrator of th
Related Questions
- Are there documentation requirements that must be satisfied before CMS can provide a written opinion on the sufficiency of a Medicare Set-aside?
- Does CMS propose that a Medicare Set-aside be established in situations that involve both a workers compensation and a liability claim?
- Once the Medicare Set-aside has been approved by CMS what is CMS subsequent role?
