SEPTEMBER 2010, CMS RELEASES SET-ASIDE STATISTICS

We recently requested CMS performance statistics for Calendar year (CY) 2005 through CY 2009 (June 2009). The following is a compilation of all the data that CMS provided.

During CY 2007 through June 2008 of all ten CMS regions, the San Francisco region processed the highest number of set aside proposals, while the Denver region processed the least number. However, the Philadelphia region yielded the greatest total Medicare Set Aside (MSA) value for submitted proposals.

The portion of settlement dollars consumed by MSAs increased. During CY 2007, the average MSA represented approximately 26% of the total case settlement value. In 2008, the average rose, to more than 29%.

The average MSA portion allocated for prescription drugs varied by region. In CY 2006 through June 31, 2009 the avg. Rx for Kansas City region was $307.00 and CMS San Francisco was $3,087.00. However, for these two regional offices, Rx allocations in CY 2007 in Kansas City increased by a whopping 2,474% and slightly higher in 2008 while San Francisco saw increases of $13,740.00 in CY 2007 and an a significant increase for CY 2009 which came in at $21,040.00. As noted above for CY 2009 CMS only provided data up through June 2009.

The percentage of MSAs that were submitted to CMS that required additional development by the Workers Compensation Review Center (WCRC) for CY 2005 and 2006, CMS requested additional material on 49% of MSA submissions in 2005 and 62% in 2006. For CY 2007, 49.5 % of submissions required additional development. In 2008 32% of all submissions required additional development. In CY 2009 (thru 6/30/2009) CMS sent development letters on 1,974 WCMS submission out of 10,448 submissions received or approximately 19%.

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