The Centers for Medicare and Medicaid Services (CMS) has released 2023 data that provides insight into its Workers’ Compensation Medicare Set-Aside (WCMSA) reviews.  This is the second year in a row CMS has published such detailed metrics.

We thank CMS for publishing these annual statistics on the WCMSA review program.  They give interested parties a better understanding of CMS MSA review trends and a baseline for comparison.

The agency provided statistics for four years from 2020 through 2023 (CMS’s fiscal year ends Sept. 30). The data compared proposed MSA amounts with the CMS-recommended amounts, which we typically call the “approved” MSA amounts.

CMS MSA recommendations are up by 9%

In last year’s analysis of the CMS data, we speculated that the 17% decline over two years represented a trend away from CMS MSA submissions. However, this report shows a 9% increase in CMS MSA recommendations from 2022 to 2023*.  While total recommendations have not reached their 2020 level, there does not appear to be a significant move away from CMS MSA submissions.  Unfortunately, CMS does not provide pre-2020 data, which would give us a better picture of total pre-COVID MSA recommendations for comparison.

*In 2022, CMS completed 13,752 reviews; by the FY end of 2023, this had increased to 15,743.

Average MSA amounts have risen.

Along with more CMS MSA recommendations, the average CMS MSA amounts have gone up. The 2023 CMS average MSA amount of $86,453 is the highest in four years, exceeding the $84,563 in 2020.

There was also an increase in the variance between proposed and recommended MSA amounts.  While 2020-2022 ranged from 13-15%, the 2023 data showed a variance of nearly 22%. This translates into more counter-highers in response to MSA submissions to CMS.

 How Tower’s MSAs Stack Up

The release of these statistics allows Tower to compare its CMS-approved MSAs against all CMS-approved MSAs.

Average CMS-Approved MSA (2022 numbers):

CMS:  $81,572                                                 Tower:  $54,715

Tower’s CMS-approved MSAs are 33% lower than the CMS average approved MSA.

And if we isolate just the prescription drug component of the MSA:

Average CMS-approved Rx Amount in MSA (2022 numbers):

CMS: $20,776                                                  Tower:  $11,405

Tower is 45% lower than the CMS average for the prescription drug component.

These metrics show that cost reductions can be obtained when payers choose the CMS MSA approval process. Tower’s MSA allocation methodology and cost mitigation through interventions, such as our Physician Follow-up service, significantly reduce MSA allocations.

Simply put, this means millions of dollars in savings to our partner clients.

CMS Will Hold a Webinar on Civil Monetary Penalties and Section 111 Reporting

CMS recently announced it will host a webinar for Non-Group Health Plans (NGHPs) to discuss the “Certain Civil Money Penalties Final Rule” and enable Responsible Reporting Entities (RREs) to ask CMS questions directly. The webinar is scheduled for January 18 at 1:00 PM ET.  CMS advised that further details will be posted in the coming weeks. Tower will provide the information when available.

If you have any questions, please contact Dan Anders, Chief Compliance Officer, at Daniel.anders@towermsa.com or 888.331.4941.