CMS Doubles Down with New WCRC Contract

On September 1, 2017, CMS awarded a new contract to Capitol Bridge, LLC, an Arlington, VA company, for the Workers' Compensation Review Contractor (WCRC). The purpose of this contractor arrangement is to independently price the future Medicare-covered medical treatment and costs, including prescription drugs, related to Workers’ Compensation injury, illness, and disease under the Medicare Secondary Payer act, on behalf of CMS (Link).

These reviews involve the commonly accepted method of forecasting care as a Medicare Set Aside (WCMSA) report for Workers’ Compensation claims. CMS issued guidance for Workers’ Compensation Medicare Set Asides (WCMSAs) has developed and evolved since 2001 for the non-group health insurance industry, but no specific guidance has been issued for Liability Medicare Set Asides (LMSAs) or No-Fault Medicare Set Asides (NFMSAs) involving liability and no-fault claims.

Surprisingly, the contract award amount is $60 Million dollars, a shocking increase from the $5 Million awarded to Provider Resources, Inc., a woman owned small business, contracted in 2011. Based on recent CMS announcements regarding Medicare Set Asides for Liability claims, the award amount suggests that CMS is anticipating a significant increase in the volume of Medicare Set Asides submitted for review and approval, despite the voluntary requirement to submit MSAs to CMS as most recently stated in the July 10, 2017 Workers’ Compensation Medicare Set Aside Reference Guide.

While no formal guidance has been released to date by CMS regarding the submission of MSAs for liability or no-fault auto claims, the new contract award amount sends a clear message that CMS is committed to Medicare Secondary Payer recovery efforts for future medical costs. Interestingly, the owner of Capitol Bridge, LLC is Nicholas Jordan, a Washington insider, graduate of the University of Virginia and former leader at Deloitte Consulting. Capitol Bridge, LLC offers financial management services among other service offerings as a government contractor.

It is a sure bet that the new CMS reviewer will be deploying new technologies to grade your submissions. Care Bridge International has developed MSA specific algorithms based on 1 BILLION workers compensation medical bill transactions and over 2800 MSAs reviewed and approved by CMS since 2008. Without a data-driven approach, you can expect delays and dissatisfaction with the new review contractor.

Whether you choose to submit your MSAs to CMS or not, our innovative and integrated platform offers the greatest risk protection or Medicare Secondary Payer at the lowest cost available in the marketplace today. Contact us to schedule a demonstration here and discover how you can protect Medicare’s interest for your Workers’ Compensation and Liability claims and settle those claims faster than ever!

Contact us!

Michael Riccio, Customer Experience Manager

Toll-Free: 888-434-9326 Ext. 103

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