In an April 15, 2026, webinar, Centers for Medicare and Medicaid (CMS) staff discussed important clarifications that will materially impact how Workers’ Compensation Medicare Set-Asides (WCMSAs) are reported under Section 111.

Several of these comments go beyond technical guidance—they directly affect whether CMS will review a WCMSA at all, how settlements are interpreted, and how Medicare coordinates benefits post-settlement.

Below are the most important takeaways, along with what they mean in practice for payers, TPAs, and Responsible Reporting Entities (RREs). A copy of the CMS slides can be found here.

Why Section 111 Reporting Now Drives WCMSA Outcomes

CMS is increasingly using Section 111 reporting as a primary enforcement tool for post-settlement compliance and coordination of benefits.

As a result, reporting errors now create direct financial and compliance exposure. They may:

• Eliminate the opportunity for CMS WCMSA review
• Trigger incorrect Medicare denials
• Create duplicate or inaccurate records in CMS systems
• Increase exposure for both payers and claimants

WCMSA preparation, settlement strategy, and Section 111 reporting must now operate as a coordinated process.

TPOC Reporting Before WCMSA Approval Ends Review

The most significant takeaway from the webinar is this:

Reporting TPOC with an MSA amount before CMS approval will effectively end the WCMSA review process. CMS explained that Section 111 reporting is treated as the payer’s definitive representation of settlement posture. Once TPOC is reported with an MSA amount, CMS assumes the parties have elected a non-submit MSA strategy and will not reopen the matter for review.

CMS clarified that:

• If TPOC is reported with a WCMSA amount, the Workers’ Compensation Review Contractor (WCRC) will not accept a new submission
• If a WCMSA is already under review, the WCRC will close the file without issuing a determination

CMS’s position is that reporting TPOC signals the claim has settled and the parties have chosen to proceed with a non-submit MSA.

Key Risk

Reporting TPOC prematurely permanently removes the ability to obtain CMS approval, even if approval was originally planned.

CMS WCMSA Reporting Requirements You Cannot Ignore

Professional Administrator EIN Reporting

While the professional administrator’s EIN is technically optional, CMS made clear that even if there is an MSA professional administrator, failing to report it will result in the MSA being treated as self-administered.

Why it matters:

When misclassified as self-administered, CMS systems generate beneficiary correspondence that may conflict with the actual trust or professional administration arrangement, increasing beneficiary confusion and compliance disputes

Case Control Number (CCN) Requirements

For CMS-approved WCMSAs, the Case Control Number (CCN) must be reported, even though optional.

Why it matters:

Because CCNs are only assigned to CMS-approved WCMSAs, their absence in reporting is a key indicator to CMS systems that an MSA was not reviewed

Funding Method Must Match CMS Approval

CMS emphasized that the reported funding method must align exactly with the approval:

• Lump sum approvals must be reported as lump sum
• Structured approvals must be reported as structured

Any change to funding requires CMS approval before reporting.

CMS Introducing Tolerance for Minor Value Differences

CMS acknowledged that small discrepancies can occur between approved MSA amounts and reported values.

To address this, CMS has:

• Eliminated sensitivity to cents
• Introduced a tolerance threshold for minor variances

This reduces technical errors, but material discrepancies will still create issues.

WCMSA Reporting for Multiple Dates of Injury

CMS maintains its position on multi-date-of-injury settlements:

• Report one TPOC and one WCMSA tied to the earliest date of injury
• Since the WCMSA covers all settling dates of injury, include all diagnosis codes associated with all settled injuries under that earliest date

Additional dates of injury should still be reported, but with:

• $0 WCMSA amounts

For example, if a settlement resolves three dates of injury, one claim should report the earliest DOI with the full WCMSA amount and all applicable diagnoses, while the remaining two claims are reported with zero-dollar WCMSAs

Common Section 111 Reporting Mistakes That Create Risk

CMS reinforced several expectations that, in practice, are common failure points:

• Report only after the settlement is finalized*

Reporting a “pending” settlement date remains unacceptable

• Ensure data accuracy across all systems

Misalignment between MSA vendors, claims teams, and reporting units is a frequent issue

• Populate all applicable fields

“Optional” fields often drive how CMS classifies and processes the MSA. As such, some “optional” fields should be considered required.

*Finalized means all settlement terms are fully executed, court approval if needed, medicals released, and no further contingencies remain.

The consistent theme: incomplete or inconsistent data leads to downstream problems for both payers and beneficiaries.

How to Adjust Your WCMSA and Section 111 Process Now

Organizations should take immediate steps to align their processes with this guidance:

• Do not report TPOC until WCMSA approval is obtained (if approval is being sought) and settlement is made final
• Always include the CCN for CMS-approved MSAs
• Treat the professional administrator EIN as required when applicable
• Validate funding method and amounts before submission to ensure they match CMS approval
• Implement controls for settlements with multiple dates-of-injury to ensure proper consolidation of diagnoses and reporting structure

Final Takeaway: Section 111 Is Now a Compliance Gatekeeper

CMS is increasing its reliance on Section 111 reporting to drive compliance and post-settlement enforcement.

Organizations that treat WCMSA approval, settlement negotiations, and reporting as separate workflows are at increasing risk of irreversible errors, particularly when TPOC is reported too early.

Getting this right now requires tighter coordination, stronger internal controls, and a more deliberate approach to settlement and reporting timing.

Tower MSA Partners helps organizations align WCMSA strategy with Section 111 reporting to reduce risk and improve outcomes. Contact our team to review your process. Please reach out to Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com with any questions.

Frequently Asked Questions