Author Archives: Donna Mize, MSCC

New WCRC, Capitol Bridge: Changes and Trends

Capitol Bridge, LLC assumed the reigns as the new Workers’ Compensation Review Contractor (WCRC) on 3/19/2018.

Immediately following the transition to Capitol Bridge, it was noted that they have a different methodology for pricing.  This has caused a slight increase in counter low/high determinations as the industry adjusts to the pricing methodology changes.

In addition to the above, Optum has found the turn around time for completed  WCRC determinations has increased from 9 days to 20 days.  Hopefully this is just a slow down due to the transition and will level out in the near future.

There have been several “hearing loss” cases which have been returned with counter high allocations for future office visits and additional audiograms over the claimant’s life expectancy.  Since Medicare does not cover ongoing office visits or testing once the claimant has been diagnosed with simple hearing loss (no other ear conditions noted), “hearing loss” claims have historically been approved as Zero MSA allocations.  Optum is currently resubmitting these cases for additional review and reconsideration of a Zero MSA allocation due to the error of inclusion of non-Medicare covered items/services.

The above changes appear to be due to the transition to the new contractor and should be temporary.  It was expected that there would be a short adjustment period as a result of the transition.   Optum will continue to report any additional trends we become aware of that will affect WCMSAs in an ongoing effort to keep our clients apprised of changes as they occur.

CMS Releases Update to WCMSA Reference Guide

The Centers for Medicare and Medicaid Services (CMS) released an update to their Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (version 2.7) with two changes. To view the reference guide, click here.

  1. Section 14.0 (page 51), Appendix 1 and Appendix 5: This update provides the new Workers’ Compensation Contractor (WCRC) phone number: 833-295-3773 and hours of business, 9 a.m.–5 p.m. EST, Monday–Friday.
  2. The Confidentiality Statement now states the Medicare beneficiary must provide a written request or explicit written consent/authorization for a party to obtain information from CMS regarding the Medicare beneficiary.

As indicated by CMS in their March 7, 2018 teleconference, Capitol Bridge is the new WCRC. No material changes were made to the reference guide related to the WCMSA review process.  Please continue to watch this site for additional updates, news or trends from CMS.

WCRC contractor transition webinar held with The Centers for Medicare and Medicaid Services

The Centers for Medicare and Medicaid Services (CMS) held a webinar on March 7, 2018, to introduce Capitol Bridge, LLC, our new WCRC contractor, and review the transition plan.

John Jenkins of CMS and Holly Havens of Capitol Bridge discussed the transition between the two WCRC contractors—the incumbent, Provider Resources, LLC, and Capitol Bridge. The last day for Provider Resources will be March 16, 2018, with Capitol Bridge beginning March 19, 2018. The transition will occur over the weekend and should not disrupt business or cause a backlog.

During the webinar, Ms. Havens confirmed the following points regarding the transition:

  • Capitol Bridge has 25 years of CMS support experience and is well versed in Medicare Set Asides. Their staff includes nurses and attorneys who are MSCC certified, pharmacists and administrative staff. Additionally, some of the existing Provider Resources WCRC staff are transitioning to Capitol Bridge.
  • There will be no change to quality or timeliness standards
  • After receipt of a submission the turn around time periods will be:
    • 20 days from the receipt of the submission, if the file does not require any further documentation
    • For a file requiring submission of additional information, the turnaround time for completion is 10 days from the receipt of all necessary documentation (a development letter will be sent).

Capitol Bridge’s contact information is:

Phone: 833-295-3773
Fax: 585-425-5390
Email: wcrc@capitolbridgeLLC.com
All correspondence must include a case control number
Operating hours are 9:00 a.m. to 5:00 p.m. eastern time, Monday through Friday

CMS stated that they expect this transition to be seamless. Mr. Jenkins confirmed no changes or updates will occur to the existing WCMSA Reference Guide and other policies and pricing will not be affected.

Optum looks forward to working with Capitol Bridge on WCMSAs, and is hopeful that the transition will be smooth and seamless as indicated. We will monitor the transition beginning March 19 and keep the industry updated on any new events or issues that arise.

New Workers’ Compensation Review Contractor (WCRC) contract awarded

Capitol Bridge, LLC has been named the new Workers’ Compensation Review Contractor (WCRC) effective September 1, 2017, succeeding Provider Resources. Capitol Bridge is a Government Services firm headquartered in the Washington Metropolitan area with offices in Arlington, Virginia, Washington, D.C., and Columbia, Maryland.

Congratulations to Capitol Bridge and we look forward to working with you.