NQBP Alert! CMS updates WCMSA Reference Guide based on Town Hall Meeting discussion

CMS adds information discussed at their Town Hall Meeting on March 11, 2013 to the WCMSA Reference Guide— Now available online!

An updated WCMSA Reference Guide has been posted and is available in the Downloads section of the WCMSA “What’s New” page. This version includes the issues covered in the March 11, 2013 Town Hall Meeting. The Guide documents the current WCMSA review process and provides more detailed information on the actions performed by the WCRC.

CMS is currently working on additional enhancements to the WCMSA process. Stakeholders will be notified of these proposed changes prior to implementation.
The following sections of the Guide have been enhanced or added:

9.4.1.1 – Most Frequent Reasons for Development Requests: The five most common omissions as provided by the WCRC.
9.4.2 – WCRC Team Background and Resources Used: The expertise of the WCRC reviewers as well as the resources used when reviewing a WCMSA.
9.4.3 – WCRC Review Considerations: Examples of the questions and factors that guide the WCRC’s review of WCMSA proposals. The overarching guidelines used in treatment allocations and pricing is also provided.
9.4.4 – Medical Review: A diagram and steps the WCRC follows in its medical review process with a general explanation of documentation requirements.
9.4.5 – Medical Review Guidelines: Considerations and examples in specific medical cases and topics.
9.4.6.1 – Prescription Drug Review: Details the process the WCRC follows in reviewing prescription medication allocations and the resources that may be used.
9.4.6.2 – Pharmacy Guidelines and Conditions: Discusses specific drug usage and pricing considerations.
10.1.8 – Pay history added to list of information needed for WCMSA submission.

Click here to review the March 11, 2013 Town Hall Meeting Notes.
Click here to review the updated WCMSA Reference Manual.

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