WCRC Contract out to bid
R — Workers’ Compensation Review Contractor (WCRC) Recompete – Competitive 8(a) project – Addendum#2- Q&A’s from RFI – Addendum#1-Draft SOW
524298 — All Other Insurance Related Activities
Department of Health and Human Services, Centers for Medicare & Medicaid Services, Office of Acquisition and Grants Management, 7500 Security Blvd., C2-21-15, Baltimore, Maryland, 21244-1850
Point of Contact
Alan F Fredericks, Phone: 410-786-8622, Mark W Werder, Phone: 410-786-7839
Small Business Set-Aside
Place of Performance
Address: Contractor Facility, United States
SN02077775-W 20100228/100226235456-73ab5182f16eccc8ff555b5f64f0e4aa (fbodaily.com)
FedBizOpps Link to This Notice
(may not be valid after Archive Date)
MEDVAL Comments: Finally, CMS has put the WCRC contract out to bid, two years after the original contract was supposed to expire. The solicitation gives some insight as to the flaws in the current program. Consider this excerpt
“The WCRC shall, IAW CMS guidelines, and acting as an impartial entity, evaluate workers’ compensation Medicare set-aside arrangement (WCMSA) proposals, and independently project the future medical costs, including prescription drugs, related to the workers’ compensation (WC) injury, illness, or disease, that would be otherwise reimbursable by Medicare. The WCRC will utilize, and work within, the CMS-developed and owned Workers’ Comp Case Control System (WCCCS), an electronic distributed case & correspondence database system, on a distributed basis from the New York City host server; as well as the RedBook prescription pricing tool. CMS will provide internet interface for the contractor’s use. The contractor shall, upon reviewing each complete WCMSA proposal(case), recommend the WCMSA dollar amount for each proposal, and which is subsequently reviewed and approved/rejected by CMS final determination. For staffing and other resource considerations, the contractor shall anticipate receiving and completing, 2000 – 2500 WCMSA proposals per month”
Look, there is no way to review upwards of 30,000 cases with the money CMS is willing to spend on this process. That is why the WCRC review program is full of mistakes, inaccuracies and just plain misinterpretation of the records. But if you read the statement of work contained in this solicitation, just look what CMS is demanding! The standards are impossible to meet within the expected budget constraints. This contract should cost $15,000,000 or more per year to effectively administer. I doubt the winning bidder will get 1/3 of that amount.
So since I have the #1 blog in the country regarding Medicare Set-Asides (out of 2 total), I am going to tell CMS what they SHOULD be asking for instead of what we ARE ultimately going to get.
1. Spend the money certifying firms and individuals to provide MSA services. Decide what qualifications are acceptable, develop uniform protocols, provide uniform training and certify interested parties.
2. Once certified, allow MSAs prepared by these firms to be reviewed and approved in a streamlined fashion. Do not waste time duplicating efforts (mostly by reading hundreds of pages of medical records that are already succinctly summarized and re-pricing medical services/Rx with outdated fee schedules and NDC numbers) and second guessing minor details. Push these approvals through in 14 days.
3. To keep the certified vendors honest, set up an audit team that will review one out of 20 MSAs submitted to make sure there are no shortcuts or deviations from CLEARLY ESTABLISHED protocols taken. If a firm is found to be in violation, revoke their certification after some due process. Generally I think the industry follows CMS protocols better than the WCRC does as it is.
4. With a portion of the contract, set up an appeals process to handle complicated cases that deviate from the norm. Abandon the one size fits all approach currently employed and take the time to review and understand matters that have additional issues in play. Also, allow this group to handle “advocacy files” where an argument needs to be made because the normal protocols do not fit the fact pattern of a particular case. This would allow more skilled vendors and attorneys to be more than a convenient conduit for CMS approvals and command higher fees for better results.
5. Open a dialog with industry stakeholders to constantly improve the process and service. The result will be a happier industry, less burdened CMS employees, better MSP compliance, a lower cost/better quality WCRC contract, less litigation, better protected claimants and a program that us not pilloried at every opportunity.
There it is. Anyone have anything to add?