CMS has published a “Helpful Hint” document which outlines areas of WCMSA submissions that frequently become an obstacle. CMS explores the following twelve areas:
- Incomplete Medical records for the last two years of treatment
- Exclusion of pertinent medical records or submitting too many records.
- Insufficient proof of medications, dosages and frequencies for the last two years of treatment.
- Carrier payments history is missing, undated, old, or incomplete
- Total settlement amount missing, unclear, or improperly computed.
- No response or insufficient response to development requests.
- Proposed set-aside amount not clearly divided between medical services and prescription drug costs.
- Submission of unnecessary, unrelated, or duplicate documents.
- Incorrect references for a state that does not have a fee schedule
- No rated age statement submitted confirming that all rated ages obtained on the claimant have been included.
- Incorrect pricing of drugs, e.g., quoting or using prices associated with re-packagers, expected tapering, etc.
- Multiple dates of injury, multiple body parts, body parts remaining open for medicals.
The document is especially helpful for folks in the claims management world as it ties together the request of the Allocation companies to the delays in obtain CMS approval. As you can see, building a full and complete submission package on the front end will help reduce delays.
FS is the leading MSP Provider dedicated to providing superior outcomes.
Katie A. Fox, MSCC