Understanding Intersection Between Workers' Compensation and Medicare: Essential Facts
Navigating the complexities of workers' compensation and Medicare is essential for those either receiving or soon to receive Medicare benefits. Here's the lowdown on what you need to know:
Workers' comp provides coverage for job-related injuries or illnesses for federal employees and more. With Medicare coined as the secondary payer in cases where workers' comp is involved, it's crucial to report these settlements to the Centers for Medicare & Medicaid Services (CMS) to safeguard Medicare's interests and avoid potential issues with medical expenses.
When to report
The rules have changed, and starting April 4, 2025, all full and final settlements involving Medicare beneficiaries require reporting, no exceptions. If a judge's approval isn't needed, report the settlement as soon as you pen the agreement.
How to report
Workers' comp payers must submit settlement details to CMS through the Section 111 reporting process, irrespective of whether CMS approval is requested.
Why report
To prevent Medicare from covering expenses that should be paid by workers' comp, reporting is necessary. Additionally, CMS may require a Medicare Set-Aside (MSA) account to ensure settlement funds are used appropriately for future medical care before Medicare covers related costs.
Failing to comply with reporting requirements can result in claim denials and potential reimbursement obligations to Medicare. CMS may also increase enforcement and audits to ensure compliance with the new reporting requirements.
Take the time to educate yourself about how workers' comp may affect your Medicare coverage to avoid future headaches with medical expenses. With clear understanding, you can ensure you're making the right moves to secure your benefits and avoid reimbursement obligations.
For more resources to help navigate the complex world of medical insurance, check out our Medicare hub. Happy navigating!
- Navigating the complex interactions between workers' compensation and Medicare requires reporting all full and final settlements involving Medicare beneficiaries starting from April 4, 2025, as failure to comply can result in claim denials, potential reimbursement obligations to Medicare, and increased enforcement from the Centers for Medicare & Medicaid Services (CMS).
- To safeguard Medicare's interests and ensure future medical care costs are paid appropriately, workers' comp payers must report settlement details to CMS through the Section 111 reporting process, regardless of whether CMS approval is requested.
- As workers' comp is the primary payer in cases where workers' comp and Medicare are involved, it's essential to report these settlements to prevent Medicare from covering expenses that should be paid by workers' comp, and to potentially require a Medicare Set-Aside (MSA) account to manage settlement funds for future health-and-wellness therapies-and-treatments under the science of health systems, as part of the broader health-and-wellness landscape.
