The WCRC, the entity which reviews Workers’ Compensation Medicare Set-Asides (WCMSAs) for the Centers for Medicare & Medicaid Services (CMS) has issued the award to Capitol Bridge LLC, a government services firm with its headquarters in Arlington, Virginia. The award notice is as of September 1, 2017 and can be found here.

Noteworthy of the award is that it is for approximately $60 million dollars, which is safe to say that CMS expects the WCRC to engage in a large number of MSA reviews. We know from the Request for Proposal (RFP) for this award that the WCRC will also potentially begin reviewing Liability Medicare Set-Asides (LMSAs) and No-Fault Medicare Set-Asides (NFMSAs) as early as July 1, 2018 which explains the large award amount, in addition to an increased volume of WCMSAs over the years. For our prior blog on CMS’ intent to establish a voluntary two-level LMSA and NFMSA review process, click here.

Since 2011, Provider Resources, Inc. has been the contractor reviewing WCMSAs. We have seen excellent turnaround times from Provider Resources and fully expect that Capitol Bridge LLC continues to provide MSA approvals expeditiously. It will be interesting to keep an eye on how Capitol Bridge reviews MSAs and also adopts updated guidance in the new WCMSA Reference Guide. Since the issuance of the Reference Guide, the industry has seen a shift in some of the WCRC’s approval policies. Namely, the current WCRC is now requiring a court order to approve a zero allocation based upon denial of the claim. Further, with California MSAs in which the employer/carrier has relied upon a binding Utilization Review (UR), WCRC is now requiring an Independent Medical Review (IMR) decision or a court order to support the UR.

Regarding the review of LMSAs and NFMSAs, Capitol Bridge will eventually implement guidance on this process with policy from CMS. With that, it is our hope that CMS and Capitol Bridge work with industry stakeholders for feedback on an LMSA/NFMSA review process so as to formulate a process that will not impede settlements.

We will continue to monitor any trends and changes in the WCMSA approval process and keep our subscribers apprised.

 


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