On March 7, 2018, the Centers for Medicare and Medicaid Services (CMS) held a transition webinar regarding its upcoming Workers’ Compensation Review Contractor (WCRC) transition. In late September 2017, CMS awarded the WCRC contract to Capitol Bridge, LLC, which is scheduled to assume WCRC responsibilities from the current contractor, Provider Resources, Inc. (PRI), on March 19, 2018. CMS held this webinar to introduce Capitol Bridge, LLC and provide substantive details related to this upcoming transition and process changes.
The webinar session was led by John Jenkins, health specialist at CMS, and Holly Havens project director at Capitol Bridge. In addition to Ms. Havens, the following Capitol Bridge, LLC team leaders were introduced: Frank Wolf, operations manager; Christopher MacTaggart, QA manager; Adriana Begley, litigation hold contact; Nicholas Jordan, executive; and Daniel Gomez, executive.
The following provides an overview of this event and its potential claims impact:
The WCRC is contracted by CMS to handle and process Workers’ Compensation Medicare-Set Asides (WCMSAs). The WCRC’s responsibilities include reviewing WCMSA submissions, responding to WCMSA case inquiries, calculating reasonable future medical treatment, and reviewing Amended Review requests. Provider Resources, Inc. has been the acting contractor since July 2012 with Capitol Bridge, LLC now scheduled to take over WCRC duties on March 19, 2018.
WCRC Transition: Timing and Details
On Friday, March 16, 2018 PRI will stop production as the WCRC, but will remain active in the transition throughout the weekend. As noted, Capitol Bridge, LLC will then officially take over WCRC operations (including handling of WCMSAs) on Monday, March 19, 2018. As part of this transition, the WCRC customer service contact information will change to: (833) 295-3773 and WCRC@capitolbridgellc.com. However, the WCRC Oklahoma mailing address will remain the same.
In addition, CMS advised the following regarding the more substantive aspects of this transition:
- The transition will not impact current review quality and response turnaround times. Review and decisions will continue to follow the current guidelines and be provided within 20 days from when the WCRC has all the necessary information on file.
- CMS does not anticipate any backlog and all the files currently in queue with PRI will be fully transitioned to the new contractor.
- Capitol Bridge, LLC has sufficient number of staff on file for a seamless transition. The review staff is comprised of MSCC certified nurses and attorneys. A pharmacist will also be on staff.
- Capitol Bridge, LLC will be exploring opportunities to streamline the present process through automation.
- CMS does not have plans to update the current WCMSA reference guide as a result of the transition.
Of note, CMS specifically stated that they would not address liability MSA questions during this webinar and did not provide any further information on the possibility of expanding its MSA process to liability and other claims.
Impact and Analysis
Overall, the webinar presentation was brief and primarily focused on the timing of the WCRC transition and post-transition WCRC contact details. While CMS and Capitol Bridge, LLC expressed confidence that the transition would not negatively impact the quality and turnaround times experienced with PRI, many process questions remained unanswered.
During the Q&A segment, several questions presented centered around whether the transition would affect the handling and frequency of development letters, if there would be any changes to the method for calculating WCMSA treatment, and the interpretation of re-reviews. Both CMS and Capitol Bridge, LLC provided only cursory responses to these questions and avoided substantively discussing any potential future policy or handling differences. Ultimately, the transition’s impact on current practices and WCMSA calculations remains to be seen, and will need to be closely monitored going forward.
ISO Claims Partners will continue to closely follow all aspects of the WCRC transition and provide industry updates as warranted. In the meantime, if you have any questions regarding the CMS transition webinar or the upcoming WCRC transition, please do not hesitate to contact Sidney Wong at Sidney.Wong@verisk.com or 978.825.8262.