CMS Data Entry Error Leads to Re-review

NuQuest staff works diligently to ensure that CMS approves proper MSA pricing. This was shown recently, when an initial CMS approval letter was higher than the MSA NuQuest submitted.

“Upon review of the CMS allocation, we noted that CMS priced the venipuncture and comprehensive metabolic panel (CMP) higher than it should be per the workers’ comp. fee schedule,” explains Nancy Heidrich, NuQuest’s Director of Clinical Services. “We also noted that the CMP was described as ‘comprehensive group’ by CMS on their allocation price of $140. This appeared to be a CMS data entry error, so we requested a re-review asking CMS to correct the pricing for the venipuncture and correct the description and pricing for what appears to be a CMP.”

Per CMS guidelines, since this re-review request was for a CMS error, no additional documentation is warranted. CMS responded to NuQuest’s request for re-review noting “no new evidence was submitted.” CMS made no changes. NuQuest pushed back for a second time. The CMS Regional Office was contacted about the situation. After more than a month NuQuest received the updated approval with CMS agreeing that the service allocated should be “comprehensive metabolic panel.” CMS repriced the venipuncture and CMP at the correct pricing. This saved the client $3,541.

Whether a substantial savings, or even just a little, NuQuest strives to ensure proper MSA pricing for our clients.

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