Yesterday afternoon, PMSI received several hundred WCMSA determinations which were noted to have been reviewed as part of a streamlined review process. The vast majority of these determinations appear to be “rubber-stamped” (approved as submitted) and related to files in which CMS had previously issued a development letter requesting additional information.
No official statement regarding this streamlined review process has been transmitted by CMS at this time. However, PMSI believes that increased pressure upon CMS and the WCRC to clear its backlog and cease seeking medical records that are either unavailable or unrelated to the injury prompted CMS to clear many WCMSA proposals.
PMSI applauds this action by CMS and the WCRC, and is grateful that continued advocacy with CMS has resulted in a positive outcome for all. While we are not certain if CMS will change any of its policies and procedures as it relates to review of WCMSAs as outlined in the reference guide, we are pleased to see that CMS is responding to issues raised by stakeholders.
We will continue to monitor the streamlined review process for any changes whether temporary or permanent and keep our subscribers updated.