CMS Issues New WCMSA Reference Guide

On November 6, 2013, CMS posted an updated WCMSA Reference Guide to the WCMSA web page.  This updated document outlines the current WCMSA review process and provides more detailed information on the actions performed by the WCRC. To view a copy of the updated Guide click here.

The following sections of the Guide have been enhanced or added:

  • – Most Frequent Reasons for Development Requests: The five most common omissions as provided by the WCRC.
  • 9.4.2 – WCRC Team Background and Resources Used: The expertise of the WCRC reviewers as well as the resources used when reviewing a WCMSA.
  • 9.4.3 – WCRC Review Considerations: Examples of the questions and factors that guide the WCRC’s review of WCMSA proposals. The overarching guidelines used in treatment allocations and pricing is also provided.
  • 9.4.4 – Medical Review: A diagram and steps the WCRC follows in its medical review process with a general explanation of documentation requirements.
  • 9.4.5 – Medical Review Guidelines: Considerations and examples in specific medical cases and topics.
  • – Prescription Drug Review: Details the process the WCRC follows in reviewing prescription medication allocations and the resources that may be used.
  • – Pharmacy Guidelines and Conditions: Discusses specific drug usage and pricing considerations.
  • 10.1.8 – Pay history added to list of information needed for WCMSA submission.

CMS has also noted that they are currently working on additional enhancements to the WCMSA process and stakeholders will be notified of these proposed changes prior to implementation.

PMSI will be completing a thorough review of this document and will provide additional information regarding changes or updates in the near future.  We will also be monitoring the WCMSA website for additional updates.

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