MSP Compliance – 2014, a Year in Review

As 2014 came to a close and we begin 2015, I have been reflecting on where NuQuest/
Bridge Pointe began as a company in 2001, how we have grown over the last 13 years
and where we are going in 2015 and beyond.

NuQuest/Bridge Pointe was built on the pillars of quality, integrity, strong customer focus
and innovation. Over the years, we have evolved from a MSA Company to a Medicare
Compliance leader. We did this by developing strong partnerships with our customers;
by developing innovative solutions; and most importantly by building a solid team of
extremely talented professionals. As we continue to grow in 2015 by adding new
customers, building stronger partnerships and continuing to focus on quality and
customer service, we will continue to learn and to evolve as the industry dictates.

We have and will continue to be cutting-edge and provide our clients with innovative
solutions to not only comply, but reduce their costs and exposure.

So as 2015 begins, I would like to share how extremely grateful we are for our customers
and look forward to another successful year of partnership.

Thank you for your trust and Happy New Year!
Tracey Lazzopina, President

MSP Compliance – 2014, a Year in Review
It will be nearly impossible to touch on every aspect of MSP Compliance in this short
review, therefore our focus will be on some of the major changes and occurrences that
impact your claim’s settlement. Let us start with the Workers’ Compensation Review
Contractor (WCRC) and the Workers’ Compensation Medicare Set Aside Portal
(WCMSAP).

The new Workers Compensation Review Contractor (WCRC), Provider Resources,
Inc., took over the responsibility of reviewing the MSA submissions and providing
the individual Centers for Medicare and Medicaid (CMS) Regional Offices with
recommendations for approval in July, 2012. In 2013, the industry experienced a shorter
turnaround time for the review process and was provided with additional published
resources to assist in understanding the process. It felt like CMS was finally taking the
industry’s concerns seriously; then came 2014.

CMS issued a new WCMSA Reference Guide on November 6, 2013, with an overview
of the operating rules and WCRC review process. By January, 2014, concerns were
growing over how the WCRC interpreted the guidelines. Inconsistent review practices
were apparent and the number of development letters being issued was increasing.
Development letters are what the WCRC and CMS call a request for additional records
and information needed to complete their review. The WCRC will not complete the
review until all requested documents are received. In January and February, 2014, the
industry noticed an increase in development letters requesting non-industrial medical
records. By March, 2014, 50% or more of submissions had an open request for additional
records including non-industrial records pending. NuQuest approached the CMS Central
Office and the WCRC – Provider Resources, Inc. regarding the development letters and
our concerns with providing non-industrial records. In March, 2014, NuQuest contacted
State Senators for assistance. After several communications and conference calls with CMS and WCRC, CMS agreed in April, 2014 to change the verbiage in the WCMSA
Reference guide and to provide the WCRC additional training.

As part of the new WCMSA Reference Guide, CMS issued guidelines of when a “rereview”
of a CMS Approval could occur. A re-review can occur under the following
circumstances:

1. You believe CMS’ determination contains obvious mistakes (e.g. a
mathematical error or failure to recognize medical records already submitted
showing a surgery, priced by CMS, that has already occurred); or
2. You believe you have additional evidence, not previously considered by CMS
which was dated prior to the submission date of the original proposal and which
warrants a change in CMS’ determination.

On February 11, 2014, CMS announced their proposed expansion of the WCMSA rereview
process which would allow for more opportunities to contest the CMS approved
MSA amount. The expansion has yet to be put in place and the re-review process
remains limited and subjective.

Similar to what we saw in 2012, CMS released mass approvals in May, 2014. MSA
submissions that were affected by the previously mentioned development letters
requesting non-industrial related records that had no bearing on the adequacy of the
WCMSA proposal and were outside of the WCRC’s scope of review, were approved as
submitted. Additionally, CMS released a new WCMSA Reference Guide changing the
verbiage that caused the development letters to be issued.