WCRC Issues Updated Reference Guide

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, News and Events on June 6, 2014
Posted by Jean S. Goldstein, JD, CMSP

With the recent exciting news of some of the backlog finally being cleared by the WCRC and CMS Regional Offices, MEDVAL was excited to learn that an updated WCMSA reference guide was issued on May 29, 2014. Some of the changes to the previous reference guide have been outlined in Appendix 6 of the updated reference guide and for quick reference can be found here. A copy of the complete updated reference guide can also be found here.

While we were certainly anticipating some changes to CMS’ current practice of reviewing submissions, we are excited to learn that based on the updated version of the reference guide, it appears that CMS will no longer be requesting that records be dated within 6 months of the submission date. The May 29 version of the reference guide does not indicate that treatment records should be dated within six months of the package submission date or date of reopening, unlike the previous version of the guide. As has been our practice, we will continue to submit treatment records for the last two years of treatment of the work injury, and will continue to monitor and track CMS’ future requests to determine if the WCRC reviewers are adhering to the updated guidelines.

The updated guide also clarifies that in denied cases, if any payments have been reflected, medical and treatment records may be requested in order for the review to be completed. Unfortunately, we have seen the CMS Review Contractor request the last two years of treatment records, even on denied cases.

We would expect the new guidelines to expedite review of future submissions, and hope to see less developments and requests for unnecessary and unrelated items. We have already seen turnaround time improve, as the WCRC has continued to clear out the backlog that was created.