Mandatory WCMSA Reporting Insights; RAMP Act Reintroduced in Congress

Mandatory WCMSA Reporting Update 

We’re now five months into WCMSA Mandatory Insurer Reporting and it is an understatement to write that many workers’ compensation (WC) Responsible Reporting Entities (RREs) have experienced issues with the rollout, particularly those who rely heavily on Medicare’s voluntary Medicare Set-Aside (MSA or WCMSA) submission process. Numerous WC payer RREs have noticed the following: 

• Medicare Electronic Data Interchange (EDI) representatives calling RRE Authorized Representatives to inquire about the validity in reporting $0 MSA allocations on files with varying settlement values; 

• Medicare’s Workers’ Compensation Review Contractor (WCRC) has ceased review of in-progress WCMSA submissions in instances where a Section 111 report has been transmitted by the RRE with a settlement amount populated (i.e. a TPOC report); 

• Approved MSAs being changed to non-approved MSAs when the WCMSA information does not exactly match what the WCRC approved, including when voluntary data is not populated; 

• Professionally administered WCMSAs being converted to self-administration when the voluntary field is not populated with the professional administrator’s EIN information; 

• The ability to use a Case Control Number (CCN) on only one record report regardless as to how many dates of injury are being resolved or when other carriers and self-insureds are relying on the same WCMSA too; 

• Medicare providing oversimplified / contradictory written guidance on reporting multi-party / multi-DOI settlements where there is no joint and several liability. 

For clients who prefer our non-submit, indemnified MSAs, you are simply not seeing many of these issues because they largely stem from overly rigid “exact match” coding by Medicare for data populating these seven new WCMSA reporting fields. 

The attorneys here at Sanderson Firm are keeping a close watch on these issues and will continue to provide updates as we learn more and guidance meantime for compliance. While we keep a close watch on these issues here and advocate directly with CMS Central as needed for our impacted clients, it is important to note that The National MSP Network (MSPN) and the MARC Coalition (MARC) have both held recent calls with Medicare to raise concerns around these issues and to seek clarification. Medicare has acknowledged the issues and is apparently working to address them. The MSP stakeholder community and industry should expect updated written guidance perhaps as early as next month, which could include adjustments to the Mandatory WCMSA Reporting fields that would take effect at least six months following such notice. 

Forthcoming CMS Webinar on CMPs

As many expected and as Medicare has indicated in various public and private discussions with industry stakeholders, we expect Medicare will host a webinar dedicated to Civil Money Penalty enforcement this fall to outline more about what the community can expect from the audit and appeals process. We will provide any specifics as soon as we learn them with respect to this widely anticipated webinar. 

RAMP Act Reintroduced in Congress

Finally, on June 20, 2025, Representatives Brad Schneider (D-IL) and Gus Bilirakis (R-FL) reintroduced the Repair Abuses of MSP Payments Act (RAMP Act, H.R. 4056) in the U.S. House of Representatives. MARC developed the bill and hopes for reintroduction in the U.S. Senate in the near future. MARC fully anticipates bipartisan and bicameral support of the bill as with its prior achievements with the PAID and SMART Acts.  

The legislation seeks to limit application of the Medicare Secondary Payer statute’s “private cause of action” to group health plans and exclude non-group health plans (workers’ compensation plans, automobile or liability insurance plans, and no-fault insurance plans) from its purview. The crux of the argument to do away with this provision is that fact that Mandatory Insurer Reporting has made the provision unnecessary. 

The attorneys here at Sanderson Firm will keep a close watch on this legislation should this be the year it gains more significant traction than it has in years past.