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Tag Archive for: WCRC

New WCRC MSA Review Contractor Capitol Bridge, LLC Introduced by CMS
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New WCRC MSA Review Contractor Capitol Bridge, LLC Introduced by CMS

There was nothing earth shattering from the Workers’ Compensation Review Contract (WCRC) webinar/conference call last week introducing Capitol Bridge, LLC (Capitol Bridge) as the new WCRC MSA review contractor that will begin reviewing proposed Medicare Set-Aside (MSA) submissions for the Centers for Medicare & Medicaid Services (CMS) beginning March 19, 2018. The call focused on Workers’ Compensation MSA (WCMSA) reviews and no questions were fielded, and therefore, no new information was provided, regarding potential Liability MSA (LMSA) or No Fault MSA (NFMSA) reviews.

Capitol Bridge takes over the WCRC as CMS’s MSA review contractor beginning March 19, 2018.
The computer user interface through the web portal will be the same as before.

The mailing address will also be the same as in the past, but the phone, fax and e-mail beginning March 19, 2018 will be as follows:

Phone: 833-295-3773
Fax: 585-425-5390 (sounded like this method was discouraged)
e-mail: WCRC@capitolbridgellc.com

Timeframes for reviews and re-reviews are projected to remain the same with a 10-day period from submission for Capitol Bridge to request additional documentation and a 20-day period from receipt of all required documentation for a MSA review decision to be transmitted to a party proposing a MSA allocation.

The acceptance date is still the submission date regardless of the method of submission (CMS web portal, BCRC P.O. Box, facsimile transmission).

One sign that Capitol Bridge Bridge intends to make the review process more efficient is that that there will no longer be a limit to the number of cases that a person may speak to a Capitol Bridge representative about on a single call. A Capitol Bridge representative also mentioned that it intends to use automation to help streamline and improve its MSA review process.
CMS review policy questions should be submitted to CMS and not Capitol Bridge.

No policy changes regarding review of MSAs were announced and it was mentioned that the current WCMSA Reference Guide (version 2.6) is not changing.  Therefore, submission of any MSA for review will continue to be a voluntary process.  The Request for Proposal (RFP) for this new WCRC MSA review contract called for centralized review of all MSA’s (previously only WCMSA reviews were centralized) so this will likely lead to more efficiency regarding the more commonly reviewed WCMSAs, as well as consistency with LMSA and NFMSA reviews (previously left to the discretion of CMS Regional Offices), once they get underway.  Stay tuned for information on how often LMSAs or NFMSAs are reviewed by Capitol Bridge in the future.  While it was not mentioned on the call, you might find this CMS website information on common MSA submission errors and hints helpful when considering submission of MSAs to CMS.

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CMS Extends WCRC Bid Solicitation Timetable to Include Additional MSA Reviews

The Centers for Medicare and Medicaid Services (CMS) has extended its original competitive bidding timetable for the Workers’ Compensation Review Contractor (WCRC) contract by a few months. This is a very important contract because the WCRC is the contractor responsible for reviewing all of Workers’ Compensation Medicare Set-Asides (WCMSAs).

The new WCRC contract bid dates are now extended, as follows:

  • Release of the bid solicitation – formerly 3.8.16, extended to 6.27.16
  • Proposal due date – formerly 4.8.16, extended to 7.27.16
  • Contract award date – formerly 6.20.16, extended to 11.7.16

Curiously, CMS stated that the reason for the extension is due to updates that are currently being made to the Statement of Work (SOW) to include the processing of other Non-Group Health Plan (NGHP) Medicare Set-aside Arrangements”. Does this mean that CMS is changing the WCMSA review thresholds, as we have heard? Or could it mean that CMS is formalizing the review of Liability Medicare Set-Asides (LMSAs), as they started to do in July 2012? We don’t know, but we will soon find out.

The other, non-timetable oriented, provisions of the WCRC contract solicitation remain unchanged, such as it being:

  • A Firm Fixed Price contract
  • For a twelve month base period with four, one-year renewal options
  • Set aside for a Section 8(A) minority-owned small business.

We will watch this issue closely and let you know as soon as something develops.

To view our previous blog about the original pre-solicitation notice, click here.

To review the original and the updated WCRC contract pre-solicitation notices, click here.

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WCRC Bid Protest Resolved

The U.S. Government Accountability Office (GAO) has announced that the bid protest regarding the selection of a new Workers’ Compensation Review Contractor (WCRC) has been dismissed. This is very good news for the settlement industry that is eager for more responsive service from the WCRC.

As we have previously reported, The Centers for Medicare and Medicaid Services (CMS) awarded a new WCRC contract to Provider Resources, Inc., of Erie, PA, which was to start on July 1, 2011. However that start date was delayed when one of the unsuccessful bidders filed a bid protest. The GAO had 100 days or until October 13, 2011 to resolve the issue but fortunately it didn’t take that long.

Sources inside CMS refused to comment on when Provider Resources, Inc. would begin, however, this should open the door for them begin reviewing Workers Compensation Medicare Set-Aside (WCMSA) proposals very soon. This is an important contract for the MSA industry because the WCRC reviews every WCMSA that is submitted to CMS for approval.

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Bid Protest Halts New WCRC Contract

It seems that the current delays in reviewing Workers’ Compensation Medicare Set Asides (WCMSAs) won’t be resolved for a little while longer .  The transition to a new Workers Compensation Review Contractor (WCRC) is on hold due to a bid protest.   The U.S. Government Accountability Office (GAO) has posted the bid protest information on its website and has 100 days, or until October 13, 2011, to resolve the issue.

WorkCompCentral, a subscription service, is reporting that one of the unsuccessful bidders is alleging that the review process was flawed and that the current review contractor, Lifecare Management Partners, will continue to review WCMSAs until the issue is resolved.  The new WCRC contract was awarded to Provider Resources, Inc. from Erie, PA.   They were set to begin on July 1, 2011.  Kind of ironic that there is a delay to fix the delay, right?

Review times by the current WCRC are running about 120 days.  This is holding up settlements and causing problems throughout the settlement industry.  The new WCRC, Provider Resources, Inc. seems well positioned to fix these problems.   We just hope that the GAO acts promptly.  We will keep you informed.

CMS Selects a New Contractor to Review Workers’ Compensation Medicare Set-Aside Proposals

The Centers for Medicare and Medicaid Services (CMS) awarded a new Workers’ Compensation Review Contractor (WCRC) contract last week to Provider Resources, Inc. of Erie, Pennsylvania.   This new contract is encouraging news to the Medicare Set-Aside and claims settlement industries because the WCRC is the sole nationwide reviewer of Workers’ Compensation Medicare Set-Aside (WCMSA) proposals for CMS, and recent delays in this process have been hampering settlements all over the country.

Provider Resources, Inc. (PRI) is headed up by Ms. Shawn Keough-Hartz, CEO and President, a 22-year veteran of the healthcare industry with extensive experience in coding, billing, compliance, IT systems and government contracting.   Dr. Dennis Agostini, PRI’s Medical Director, has a resume that is equally impressive with advanced degrees in chemistry and osteopathic medicine, and over 30 years of experience in directing organizations’ medical policies and programs.   Dr. Agostini also served our country as a Major in the US Reserves, Medical Corps during Operation: Desert Storm.   PRI has experience working with CMS as a Recovery Validation Contractor in CMS’s Recovery Audit Contractors Program.  PRI will be working with a currently unnamed subcontractor in Richmond, VA.

The $5,124,084.00 contract is for one year, starting on July 1, 2011 and ending June 30, 2012, which includes a 3-month transition period and a 9-month base production period.  After the first year, there are four separate 12-month option periods, which can be exercised at the discretion of the government.

The contract requires that all WCMSA proposals be reviewed within 20 business days of receipt, and anticipates a volume of 2,000-2,500 WCMSA proposals per month.  “High-priority” cases for severe claimant financial hardship, catastrophic health problems, or those with “congressional interest” must be reviewed within 2 business days.  Specific contract provisions require PRI to notify the submitter within 5 days if there is any missing information, and then complete the review within 15 days from the receipt of that missing information.

Education and outreach activities are an integral part of the contract.  PRI is required to “continuously” and “proactively” educate employers, insurers, attorneys, providers, suppliers and beneficiaries by use of seminars, workshops, presentations, conferences, webinars and print material.

Additionally, the contract requires that the WCRC staff include a physician, a pharmacist, pharmacy technicians, and an attorney; something that the MSA industry has been requesting for years.

Can Provider Resources, Inc. meet these rigorous contract requirements?  I’m not sure, because I’m battle wearied from the current 90-120 day turnaround times.  But, I’m optimistic.  PRI appears to have the qualifications and experience, and just the letting of this stringent contract shows that CMS is serious about trying to fix the current problems.

WCRC contract detail can be found here.