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By Settlement Solutions, June 27, 2011 2:35 pm

Over the past year CMSCenters for Medicare and Medicaid Services has been seeking a new and qualified vendor to take on the role of the WCRCWorkers’ Compensation Review Contractor through a Request for Proposal (RFPRequest for Proposal) process. On June 16, 2011, CMSCenters for Medicare and Medicaid Services awarded Provider Resources Inc. with the WCRCWorkers’ Compensation Review Contractor contract. The award notice posted by CMSCenters for Medicare and Medicaid Services on June 23, 2011 outlines the primary responsibilities of the WCRCWorkers’ Compensation Review Contractor to include evaluating MSAMedicare Set-Aside proposals while adhering to CMSCenters for Medicare and Medicaid Services guidelines, and projecting future Medicare covered medical costs including prescription drugs and durable medical equipment. However, CMSCenters for Medicare and Medicaid Services subsequently reviews the case and makes the final determination. The contract will go into effect on July 1, 2011, ending on June 30, 2012, and is worth $5,124,084 which includes the cost to transition cases from the current vendor.

Also important to note is the WCRCWorkers’ Compensation Review Contractor’s responsibility to perform outreach, educational activities, and contribute technical input, and workers’ compensation technical information to CMSCenters for Medicare and Medicaid Services, in addition to tracking, capturing, and reporting metrics each month on activities.

Providers Resources Inc.’s primary services include solutions for program integrity, quality, education, conference planning and information technology. Their primary facility is located in Erie, PA with a subcontractor facility in Richmond, VA. In addition to CMSCenters for Medicare and Medicaid Services, Providers Resources Inc. has worked with a variety of governmental programs, such as the Office of Inspector General/United States Postal Service (OIG/USPS), the National Institutes of Health (NIH), and the Veteran’s Administration (VA).

We are hopeful that CMSCenters for Medicare and Medicaid Services will provide additional information regarding the transition of current cases as well as contact information for the new contractor in the very near future. PMSI will keep our clients advised of any and all new developments and announcements related to the transition.

To review a copy of the Notice of New Award click here.

For additional information on Providers Resources Inc. visit their website by clicking here.

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By Settlement Solutions, June 23, 2011 10:52 am

The reporting required by CMSCenters for Medicare and Medicaid Services to fulfill Mandatory Insurer Reporting (MIRMandatory Insurer Reporting) requirements went live on January 1, 2011. The processes to achieve full compliance are complex and require extensive technology, data scrubbing and timely submission for entities that must report claims. Many reporting entities have encountered difficulties, including significant issues with data validation—resulting in either not reporting eligible claims or unnecessarily reporting ineligible claims to CMSCenters for Medicare and Medicaid Services. These data issues can increase risk for payers, as data reported with errors can result in temporary suspension of reporting with CMSCenters for Medicare and Medicaid Services, increasing the risk of non-compliance penalties. Following is a sample of some of the challenges RREsResponsible Reporting Entities - payers subject to Mandatory Insurer Reporting Requirements mandated by Section 111 of the MMSEA face in meeting compliance and the potential results of these issues.

Continue reading 'Common Issues in MIRMandatory Insurer Reporting Reporting'»

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By Settlement Solutions, June 22, 2011 1:30 pm

In Haro v. Sebelius, putative class Plaintiffs, Medicare beneficiaries and an attorney representing the beneficiaries challenged the CMSCenters for Medicare and Medicaid Services program for reimbursement of Medicare conditional payments under the MSPMedicare Secondary Payer Act and were rewarded for their efforts with a win against CMSCenters for Medicare and Medicaid Services in Arizona District Court. In times when CMSCenters for Medicare and Medicaid Services is broadly and according to some commentators, exceeding its authority when attempting to enforce the provisions of the Medicare Secondary Payer Act (MSPMedicare Secondary Payer Act), it is refreshing to find an example of CMSCenters for Medicare and Medicaid Services being challenged. [1]

Continue reading 'Haro v. Sebelius – Medicare Conditional Payment Collection'»