CMS Will No Longer Review $0 Medicare Set-Asides As of 7/17/25: What It Means and How Sanderson Firm Protects You with Our Zero iMSAs
As we previously blogged about earlier this year, the Centers for Medicare & Medicaid Services (CMS) will no longer review zero Medicare Set-Aside (MSA) allocations as of this week, officially on July 17, 2025. For workers’ compensation insurance carriers and self-insured employers who have until now preferred the security of CMS submission and approval for zero allocations on settlements that exceed the applicable workload review threshold, this creates new scenarios to consider.
As a refresher, a zero MSA is typically appropriate in two scenarios:
1. Legal Zero: the workers’ compensation payer or self-insured employer denies compensability for the claim(s) and does not pay any medical or indemnity benefits (beyond any applicable pay without prejudice statute), or a court/commission/board determines, by a ruling on the merits, that the workers’ compensation payer or self-insured employer does not owe any further medical or indemnity benefits
2. Medical Zero: to a reasonable degree of medical certainty, the treater indicates in writing that the injured worker does not require future Medicare covered injury-related care in the future.
Outside of the parameters outlined by CMS in their WCMSA Reference Guide, there may certainly be other situations in which parties may “reasonably recognize” Medicare’s interests with a zero MSA. Regardless as to the basis for the zero MSA, CMS review and approval is no longer available.
It is our understanding that some payers, due to being “sticklers” for obtaining CMS approval, are considering submitting funded MSAs to CMS on these cases that otherwise clearly qualify for zero allocations. By submitting a funded MSA, and not settling with a zero MSA, the payer could obtain CMS review and approval, but the payer would be unnecessarily overfunding the settlement, possibly providing a windfall to the injured worker. Additionally, such action essentially admits compensability in CMS’ view, which potentially contradicts Section 111 reporting data, and could complicate Medicare’s conditional payment recoveries on the claim.
Here at Sanderson Firm, we believe the ideal option for parties is to still settle and to use our non-submit indemnified zero MSA. Our Zero iMSA ensures the parties have adequately and reasonably considered Medicare’s future interest, and appropriately documents the applicable standard outlined in CMS’ WCMSA Reference Guide and/or other relevant bases for the zero allocation. Furthermore, our Zero iMSA includes a settlement addendum which will be attached to the settlement and release agreement to ensure that all Medicare Secondary Payer issues implicated because of the settlement have been appropriately addressed.
As a result, our Zero iMSA 1) provides a defensible zero MSA report, 2) provides custom Medicare Secondary Payer-specific settlement agreement language, and 3) provides indemnification to all parties to the settlement in the event CMS later determines that a zero MSA was improper. Additionally, the Zero iMSA saves the parties so much time since they don’t have to wait for CMS’ review and approval and saves money since the payer isn’t paying more than what is legally required.
At Sanderson Firm, we understand how critical it is to resolve claims efficiently while protecting all parties from post-settlement Medicare exposure. That’s why we’re proud to offer our Zero iMSA—a strategic, legally sound solution that provides peace of mind since CMS review is no longer available.
Zero iMSAs: The Sanderson Firm Advantage
Sanderson Firm’s Zero iMSA offering eliminates uncertainty and replaces it with legally backed assurance. Our solution includes:
· Expert Legal Analysis – every file is carefully reviewed by our MSP attorneys to determine whether a $0 allocation is legally appropriate. Once the $0 allocation is complete and settlement terms are reached, our MSP attorneys review all relevant settlement paperwork and prepare a Medicare addendum for the workers’ compensation attorneys;
· Formal Documentation – we provide a full evidentiary record supporting the zero allocation, including relevant medical and legal rationale;
· Indemnification Coverage – Our Zero iMSAs are fully indemnified for all parties to the settlement, meaning Sanderson Firm fully financially stands behind the recommendation. If Medicare ever challenges the allocation, we’ve got you covered;
· Fast Turnaround – time-sensitive settlement? We prioritize responsiveness and accuracy.
Why It Matters More Now Than Ever
As CMS steps back from reviewing certain MSAs, the burden shifts to the settling parties to document and defend their decisions. A DIY $0 MSA or vague justification simply won’t stand up to post-settlement scrutiny. That’s why partnering with a firm that offers indemnified, legally sound zero allocations is not just smart, it’s essential.
Don’t let CMS’s policy shift slow your settlements or increase your exposure. With Sanderson Firm’s Indemnified Zero iMSA, you get the protection you need. Interested in our iMSA or other Medicare Secondary Payer services? Contact us here!
