Highlights of CMS’ WCMSA Town Hall Teleconference

The Centers for Medicare and Medicaid Services (CMS) held its first ever Workers’ Compensation Medicare Set-Aside (WCMSA) Town Hall Conference today.

After introductions, Provider Resources, Inc. (PRI), the new Workers’ Compensation Review Contractor (WCRC), introduced their staff and provided a review of their WCMSA review process.

Below are some highlights and observations of the Town Hall Teleconference:

  • The WCRC has assembled an impressive team of well qualified experts to review WCMSAs including: doctors, nurses, certified coders, case managers, life care planners, lawyers, pharmacists, etc.
  • The WCRC uses Evidence Based Medicine guidelines to review WCMSAs.
  • The WCRC provided a specific, detailed and transparent explanation of the ten steps reviewers use to evaluate WCMSAs.
  • The WCRC’s chief pharmacists provided detailed guidance on PRI’s drug review guidelines.
  • The CMS website is being redesigned to provide better information to stakeholders.
  • While CMS does not have a formal appeals process, it does have an informal re-review process that has been in place for many years.
  • CMS and the WCRC will continue to strive to provide clear instructions and transparency.
  • CMS received over 100 questions in advance regarding this teleconference.
  • A transcribed copy of the teleconference will be provided on the CMS website in about two weeks.

Overall, it was a very impressive teleconference call.  Barbara Wright, from CMS closed the call by stating that CMS is striving to provide clear instructions and improved transparency so that the entire process can be as accomplished as seamlessly as possible.


Leave a Reply

Your email address will not be published. Required fields are marked *