Will the WCRC Award Be Announced Tomorrow?

CMS, Medicare Set-Aside Blog, Medicare Set-Asides, WCRC on June 29, 2017
Posted by Jean S. Goldstein, JD, CMSP

Tomorrow is June 30.  Per the Centers for Medicare & Medicaid Services (CMS), we are expecting that the Workers’ Compensation Review Contractor (WCRC) award will be announced tomorrow.  The WCRC is the entity responsible for projecting future medical costs that would otherwise be reimbursable by Medicare, for those cases submitted as related to a workers’ compensation injury, illness, or disease

The notice regarding the WCRC contract going out for bid was first issued on February 22, 2016, and since then there have been several extensions for final bid responses and a few unconfirmed possible changes to the Medicare Set-Aside (MSA) review process.  At this time, we know that under the new WCRC some of the following changes are a possibility:

  • Review of MSAs might be extended to MSAs for liability settlements (LMSAs) (possibly coming in 2018, as we previously reported) with potentially, a revision to the current workload review thresholds for these MSAs;
  • A plan of action may be implemented to reduce the number of developments, or requests for additional information experienced during the MSA review process; and
  • Possible expansion of the re-review process to cases where settlement has not occurred and a Claimant’s care has changed substantially. In addition to consideration of circumstances for situations in states that rely on the utilization review process, as we previously blogged about.

As with many in the Medicare Secondary Payer community, we are anxiously awaiting CMS’ announcement.  We will be sure to update you on any announcements regarding the WCRC award, and for now stay tuned.