Rasa Fumagalli, JD, MSCC
CMS announced the new Amended Review process in the July 2017 updated WCMSAP guide and in the updated WCMSA Reference Guide. Within days of the releases, NuQuest submitted an amended review seeking a significant reduction in CMS 2014 WCMSA determination of $2.3 million. As expected, the amount of the CMS determination had thwarted the settlement. The basis of the request for an amended review was claimant’s successful completion of an opioid weaning program in 2016. Although CMS initially declined the amended review, NuQuest’s team continued to push for the review finally securing a revised determination in the area of $628,000. Review your open cases too and see if the amended review process may work for you.