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.
* * * * *
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.
From the 07/01/2011 Medivest Blog (see online at medivest.com)