On Wednesday March 7th the Centers for Medicare & Medicaid Services (CMS) introduced the new Workers’ Compensation Review Contractor (WCRC). Effective Monday March 19th, Capitol Bridge, LLC will take over the WCRC responsibilities currently held by Provider Resources, Inc. The forty minute conference call provided an overview of Capitol Bridge’s background and how the contractual transition will work. Here’s a recap of the webinar:
Who is Capitol Bridge LLC and what will they be doing?
Capitol Bridge presented itself as a veteran of Federal agency contracting. Capitol Bridge will adhere to the same guidelines as PRI. Capitol Bridge and CMS representatives suggested no major changes to the Medicare set aside (MSA) review process.
MSAs will still be eligible for submission via the electronic portal. Most high volume submitters will use the portal to submit just about all portal-eligible MSAs.
Prescription drugs will still be calculated using AWP; future medical care will still be evaluated based on the guidelines in the WCMSA Reference Guide; and the calculation methodology will not change.
So, if all goes well, we should see no major changes. Unlike the prior contractor transition, Capitol Bridge will not inherit a large backlog of un-reviewed Medicare set asides. Nevertheless, Capitol Bridge and CMS explained that beginning on March 1st a nightly backup has been taking place to ensure that no cases are lost during the transition.
What are some things to be on the lookout for?
The WCRC contract calls for the contractor to assume a role in reviewing liability MSAs and no-fault MSAs. Medicare and Capitol Bridge declined to comment on LMSAs and NFMSAs. Interestingly, CMS did mention that there are a “number of listening sessions” scheduled in this arena. Last October CMS explained that no changes to the (currently non-existent) LMSA policy would be made without stakeholder involvement. While listening sessions are certainly worth exploring for CMS, we would strongly encourage the agency to seek a wide variety of stakeholder input to ensure that decision-makers are not selectively listening to what the agency wants to hear.
In addition, Capitol Bridge representatives explained that they were working on ways to automate the process of MSA review. The goal, as expressed by Capitol Bridge, appears to move information through the review process more predictably and, more specifically, to “automate as much as we can in the interest of quality.” Automation is certainly a worthy endeavor.
Submitters would argue that CMS review is already too automated. CMS reviews already focus far too much on lifetime care when a more nuanced, evidence-based approach would be more efficacious. So, injecting automation in this process will only work for claims payers, submitters, and beneficiaries if it applies a realistic, ideally evidence-based approach to future medical care. This is often easier said than done, and perhaps the biggest surprise on the call is that this topic was even mentioned.
Time will only tell how the new contractor performs. It is worth noting that in its bid protest decision the Government Accountability Office noted that CMS flagged Capitol Bridge’s process as “very inefficient” and possibly resulting in a higher risk of accumulated backlogs. We certainly hope that is not the case, but it is something that bears close watching.
ExamWorks Clinical Solutions will closely monitor this important transition. For questions about the new WCRC or Medicare set asides in general, please contact Marty Cassavoy at 781-517-8085 or firstname.lastname@example.org.