iMSAs: A Dangerous Deal, What You Need to Know Before you 'Buy" in

The market for guaranteed Medicare Set-Aside arrangements in workers' compensation cases remains complex and often opaque. This complexity has unfortunately created opportunities for products promising simplicity and cost savings, but which may carry substantial risks. One such product is the Indemnified Medicare Set-Aside (iMSA). While the concept of an iMSA—an evidence-based estimate of future Medicare-covered medical expenses designed for the purpose of sidestepping CMS review—is appealing, potential downsides require careful consideration. Particularly in a new era of heightened compliance scrutiny in which Medicare will be notified as of April 4, 2025, of not only those iMSA values, but also that the parties chose not to submit them for Medicare’s approval.
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Impact of Section 111 Reporting on Conditional Payment Resolution

With all of the recent changes, updates, and alerts coming from CMS, it is important to remember that various aspects of MSP compliance directly impact one another. Namely, Section 111 reporting and conditional payment appeals. This past week, AKCS was tasked with resolving a lien in excess of $350,000 and a detailed analysis of the Section 111 reporting proved to be key in reducing this amount to $0.
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WCMSA 4.2 Update

The Centers for Medicare & Medicaid Services (CMS) has released the latest version of the WCMSA Reference Guide. Effective July 17, 2025, CMS will no longer accept or review WCMSA proposals with a zero-dollar ($0) allocation. Entities must now consider specific parameters to determine if a $0 WCMSA allocation is appropriate and maintain documentation to support that allocation.
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Updated NGHP User Guide Outlines New Warning Flag for Open ORM Claims

On October 7th, CMS released Version 7.7 of the MMSEA NGHP User Guide with a few key updates. This iteration adds additional information regarding the steps needed and the emails that are issued during RRE registration, specifically Ch. 1 Table 7-1, Ch. 2 Table 6-4, and Ch. 4 Table 12-1. In general, these tables provide an easy-to-read overview of the registration process from TIN input, to PIN verification, and RRE vetting. Version 7.7 also adds some clarity to the reporting of wrongful death claims. Ch. 3 has added a note indicating...
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CMS Announces Updates to Section 111 COBSW Portal

On August 8th, CMS issued an alert confirming that COBSW system updates are coming soon. The Section 111 Coordination of Benefits Secure Website (COBSW) provides general information on Section 111 reporting, links and instructions, reference materials including various user guides, as well as a secure portal which provides the ability to manage your RREs, run Medicare entitlement queries, perform DDE reporting, and obtain query and claim response files. The upgrades...
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CMS Releases NGHP Section 111 User Guide Version 7.4 and Top Ten Reporting Errors from 2023

CMS has released its first version of the Non-Group Health Plan Section 111 Reporting User Guide of 2024. Not long after a recent informational webinar regarding Civil Monetary Penalties held on January 18, CMS released version 7.4 of the User Guide, in which the primary update is the addition of Ch. III, sect. 5.1 - Civil Monetary Penalties. This addition does not contain any surprise details that were not a part of the informational webinar, or prior communications regarding CMPs, but rather provides a general overview of what may subject an RRE to penalties, when, and how, as well as a description of CMS’ audit methodology. The full update can be found here - https://www.cms.gov/medicare/coordination-benefits-recovery/mandatory-insurer-reporting/user-guide. However, a brief summary of the additions outlined in section 5.1 are:
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