What is the referral process for submission of a proposed Medicare Set-aside to CMS?
A43. When CMS first started the Medicare Set-aside review process the submission process went something like this: The settlement proposal with the proposed Medicare Set-aside was sent to the CMS Coordination of Benefits Contractor (COBC). The inquiry would be directed to the attention of the Regional Office Medicare Secondary Payer Coordinator, who then would forward the inquiry to the appropriate CMS Regional Office. Workers’ compensation Medicare Set-aside responsibilities were generally, but not always, assigned based upon CMS Regional Office responsibility for contractor oversight over the lead fiscal intermediary for workers’ compensation recoveries for a particular state. This could or could not have been the same CMS Regional Office as the one with general responsibilities for a particular state. Starting in 2004, instead of direct submission to the CMS Regional Office, Medicare Set-asides are submitted to the Coordination of Benefits Contractor (COBC). Prior to August 27, 2007
Related Questions
- If the injured party or his/her representative disagrees with the amount that CMS has determined for the Medicare Set-aside is there any appeal process?
- Is a Medicare Set-aside analysis prepared by a commercial vendor absolutely necessary for submission of a Medicare Set-aside to CMS?
- What is the referral process for submission of a proposed Medicare Set-aside to CMS?
