The WCMSAP or Workers’ Compensation Medicare Set-Aside Portal has been improved to allow for two type of reconsiderations. These reconsiderations have been broken down by CMS into the follow two options:
If you believe CMS’s determination contains obvious mistakes (e.g., a mathematical error or failure to recognize Medical records already submitted showing a surgery, priced by CMS, that has already occurred).
If you believe you have additional evidence, not previously considered by CMS, which was dated prior to the submission date of the original proposal which warrants a change in CMS’s determination.
The overall impact is that the industry now has an outlined process to utilize the electronic submission for reconsiderations. Previously, the industry experienced delays due to mailing, scanning and processing of reconsiderations. Moving forward, we should all experience an improved process thus moving files to settlement in an effective manner. It is important to remember that the WCMSA review process is only one piece of the three prongs to Medicare Compliance. The Conditional Payment Process and Mandatory Insurer Reporting remain unchanged.
Katie A. Fox, MSCC – VP Client Management