Highlights of the 4-11-2013 CMS Town Hall meeting

Highlights of the 4-11-2013 CMS Town Hall meeting

On April 11, 2013, CMS hosted a WCMSA teleconference for stakeholders of the WC-MSA submission process. CMS attendees included:

Cynthia Gross, Contracting Operating Officer
Elizabeth Poole, Alternative Contracting Operating Officer
Barbara Wright, Senior Technical Advisor of the Medicare Secondary Payer Operations
John Albert, Acting Director of Medicare Secondary Payer Operations.

Attendees from the new Workers’ Compensation Review Center Contractor (WCRC), Provider Resources, Inc. included:

George Voorhis, MD., Program Director
Maria Templeton, Operations Manager
George Constantino, Medical Director
Angela Wolfe, Team Lead
Yasmin Muscar, Esq.
Elliot Cook, Pharmacist

The CMS WCRC clarified their general objectives for the town hall meeting which were to enhance both internal and external customer service, increase transparency of the WCRC determinations, increase pricing accuracy and identify any improvements to the overall process. The WCRC reviewed the steps involved in the review process as well as their review and pricing methodology.

Per the WCRC, there are 10 steps involved in the review process:

  1. Data verification
  2. Verifying the total settlement amount
  3. Identification of dates of injury and confirming that medical is closing out
  4. Confirm break down of both the Medical and Prescription portion of the MSA
  5. Identify calculation methodology used to price services
  6. Identify MSA funding or payment method and MSA administration method
  7. Confirm Rated Age
  8. Confirm all necessary records are received
  9. Independent review of medical records and preparation of costs
  10. Decision rational

The independent review of the medical records is the most critical of the 10 steps in the review process as well as the WCRC methodology of calculation. This is consistent with the WCRC review methodology of not using global fees or frequencies for a particular service, taking into consideration the claimant’s current health status, recommendations and prior treatment patterns, as well evidence based medical guidelines and state law.

We can only applaud the CMS and WCRC for hosting the Town Hall meeting and allowing the interested stakeholders a glimpse in the CMS approval process from their perspective and hope that CMS continues to organize such events to increase the transparency.

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