What are the review thresholds set by CMS?
A39. All workers’ compensation regardless of amount must be considered for current Medicare beneficiaries. For civil liability settlements refer to Q21. Comment: CMS is fond of using the term Aprotect@ in discussing the Medicare Set-aside process, e.g. Medicare’s interests must be protected. There is no requirement for attorneys to “protect” the interests of Medicare. Rather, the obligation is to give Medicare’s interests due consideration. The attorney’s sole obligation is to protect the interests of his or her client. Currently there are no established thresholds for liability settlements. The thresholds for review of a workers’ compensation Medicare Set-aside proposal are only CMS workload review thresholds, not substantive dollar or “safe harbor” thresholds for complying with the Medicare Secondary Payer law. Under the Medicare Secondary Payer provisions, Medicare is always secondary to workers’ compensation and other insurance such as no fault and liability insurance. Accordingly,
