CMS Issues New WCRC Award: Experts Weigh In

A new Workers’ Compensation Review Contractor (WCRC) award has been issued by CMS. The new WCRC contract was awarded on September 1st, 2017, to Capitol Bridge, LLC of Arlington, Virginia, a certified small business entity. The contract is worth $60,759,236 – an increase of $5,124,084 from the previous Provider Resources contract awarded in 2011.

CMS describes that the purpose of the WCRC is “to independently price the future Medicare-covered medical services costs related to workers’ compensation injury, illness, and disease, and to price the future Medicare-covered prescription drug expenses.”

The award follows several months of work by Provider Resources and this announcement was watched closely by the industry. We reached out to national Medicare Set-Aside (MSA) vendors to get their take on the award.

Gwen Bourgeois, Account Executive with NuQuest whose territory includes Louisiana, explained that her company is taking a wait-and-see approach. “If history repeats itself, NuQuest has found there tends to always be hiccups when CMS starts to utilize a new vendor. However, we have heard some of the employees from the prior contractor will stay on, which could aid in the transition,” she said.

“We should expect to see some variances in how the new WCRC interprets the CMS guidelines. While CMS has made significant improvements in its turn-around-times, we may also see fluctuations in the timeframes we have become accustomed to. But as with the contractors before, we will not only adapt to the changes they impose, but always maintain an open line of communication to voice concerns and discuss issues,” Bourgeois predicted.

For her part, Jean Goldstein, Legal and Corporate Affairs Manager with MEDVAL, voiced concern about the uncertainty surrounding the new contractor. “We don’t know a lot, unfortunately,” she said. “We do know from the Statement of Work that there will be some changes, they may be adding a liability MSA review process for one thing.”

Asked about the more than five million dollar increase in the contract award amount, Goldstein said that CMS has “hinted” at an increase in the volume of MSAs submitted. “They also recently updated the [WCMSA] reference guide, which could mean a shift in priorities that makes some cases and the overall contract more valuable,” she continued.

Regarding the contract valuation more generally, the $60,759,236 number itself has some confusion surrounding it. “It’s not clear how that $60 million gets paid out,” Goldstein said. “It’s a one year fixed contract with four one year renewal options, but that could mean the full amount in one year or broken down into five years.” Goldstein also indicated that MEDVAL is anticipating new rules and guidance that CMS will likely issue on October 1st, 2017, which could clarify the new contractor’s methods.

Capitol Bridge LLC describes itself as “a Government Services firm headquartered in the Washington Metropolitan area” and “an SBA certified 8(a) firm with extensive experience providing services in several areas including: Eligibility and Enrollment, Case Management, Claims Management, Records and Data Management, Cyber Security, Acquisition Support, and Financial Management.”

Get updates on CMS activity in the MSA space by referencing its “What’s New” page here.



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