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CMS to Solicit Competitive Bids for Medicare Set-Aside Review Work

The Centers for Medicare and Medicaid Services has announced that it intends to release a solicitation for competitive bids for the Workers’ Compensation Review Contractor (WCRC) on or about March 8, 2016, with an award date of June 20, 2016. It will be a Firm Fixed Price contract with a 12-month base period plus four one-year renewal options. The contract will only be available to Section 8(A) minority owned, small businesses.

The current WCRC contractor, Provider Resources, Inc (PRI), reviews about 29,000 Medicare Set-Asides (MSAs) per year under what appears to be a $5,124,084 per year contract, for an astonishing modest revenue amount of $180.00 per MSA review. They began on July 1, 2011 when the MSA settlement industry was grinding to a crawl with 7-month turn around times. Kudos to Shawn Keogh-Harz, President and CEO of PRI, for successfully reducing turnaround times to 2-4 weeks, while also increasing customer service and improving first-pass approvals. CMS also deserves praise. They did a great job in selecting PRI and working closely with them to improve performance. While we hope that PRI will continue, we are optimistic that whoever the next contractor is will resume the good outcomes of the past few years.

Although the current WCRC contractor has done a great job, we believe that there is a better way to achieve the goals of MSA compliance (which again is to save Medicare money), than focusing so many resources on reviewing WCMSAs. We will address that in our next blog post.

To view the 2.22.2016 CMS WCRC pre-solicitation notice click here.

To view our 2011 blog post announcing the WCRC contract award to PRI, click here.

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