NuQuest/Bridge Pointe has had several meetings with CMS over the past few months to resolve the ongoing problem with development letters and increased amount of requests for additional records resulting in extreme delays. As a direct result of these meetings, NuQuest/Bridge Pointe received 810 approval letters from CMS last month, and this week, CMS has updated the Submission Reference Guide Version 2.2 to give clear review processes and guidelines for the WCRC to follow. These updates include:
- Clarification of the initial submission requirements for medical records and payment records. CMS removed the following:
If you believe the last two years of treatment are unrelated to the work injury, send those medical records in addition to those related to the work injury, along with any explanation you believe is necessary.
- CMS also amended the following:
- Added Section 4.1.4 on Hearing on the Merits of the case
- Removal of the reference to Drug Tables for physician-dispensed drugs
- Combined sections on Drug Tapering and Drug Weaning
- Added Wisconsin to the list of states with no WC fee schedules
- Added Appendix 6, List of Previous Version Changes
Additionally, CMS has agreed to the following to ensure their internal review processes are streamlined:
- Meet with the WCRC to communicate the reference guide updates to ensure the processes are clearly followed.
- Amend the language in the development letters to request specific documents and information the analyst needs to complete the review.
We have a follow-up meeting with CMS Central Office for an update on their progress in two weeks. NuQuest/Bridge Pointe will keep you posted on any new developments and updates. We appreciate any feedback and comments you may have and request you direct them to me at TLazzopina@nqbp.com.