New CMS MSA Review Contractor: Different Name, Same Policy and Procedures

March 07, 2018 By: Daniel Anders
cms

While the review contractor is changing, the Workers’ Compensation Medicare Set-Aside (WCMSA) review policies and procedures remain the same. This was the message related to attendees of the Workers Compensation Review Contractor (WCRC) transition webinar held by CMS, yesterday, March 7, 2018. The purpose of the webinar was to introduce the WCMSA community to the new WCRC and provide information on the transition from Provider Resources, which ceases its work on March 16, 2018, to Capitol Bridge, which commences its work on March 19, 2018.

John Jenkins, CMS’s Health Insurance Specialist overseeing the WCRC contract, led off the presentation and then turned it over to Holly Haven, Capitol Bridge’s WCRC Project Director. Ms. Havens provided the following key information:

What is Not Changing

  • As our program matures, we will strive to improve both the quality of our work and the timeliness in which cases are completed through automation and our continual improvement focus.
  • The review and decision making process will remain the same.
  • WCMSA proposals will continue to be submitted through the portal or by mail to the same Oklahoma City address.
  • All established timeframes remain the same.
  • All inquiries will be handled by staff in our Pittsford, NY office, and customer service will be a priority.
  • Inquiries may still be communicated via telephone.

In summary, Capitol Bridge will continue to be guided by the guidelines laid out in the CMS WCMSA Reference Guide and maintain the 20-business day turnaround time for review of a WCMSA as required by CMS.

What is Changing

  • Processing of all cases will be handled out of their facility in Pittsford, NY.
  • New phone number for the WCRC is (833) 295-3773 with customer service hours from 9am to 5pm EST.
  • Email address for the WCRC is WCRC@capitolbridgellc.com
  • Fax number is (585) 425-5390

In the Q&A session following the formal presentation additional information was provided:

  • WCMSAs will be reviewed by RNs with the MSCC credential.
  • The WCRC staff includes attorneys, physicians and pharmacists.
  • WCMSA proposals which have not been reviewed by the outgoing contractor by March 16 will be transferred to the new contractor for review.
  • In response to a question as whether to expect an MSA backlog such that review times will lengthen, CMS noted that the outgoing contractor was typically completing its reviews in less than the required timeframe of 20 days.The implication then is the new contractor may be using the full 20 business days to complete its review.
  • A question was raised regarding Liability MSAs, but no answer was given as the webinar was not for the purpose of addressing policy questions.

While the CMS WCMSA policy remains the same, the interpretation and implementation of that policy will soon be in new hands. Tower MSA will be closing monitoring WCMSA reviews through Capitol Bridge to ascertain what, if any, differences can be identified in the allocation of care in the WCMSA compared to the prior contractor. Variances outside of established CMS guidelines will be challenged.

If you have any questions, please contact Dan Anders, Chief Compliance Officer, at 888.331.4941 or Daniel.anders@towermsa.com.

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