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New WCRC Contract Negotiations Continue

Recently, the Centers for Medicare & Medicaid Services (CMS) awarded a new contract for Workers' Compensation Review Contractor (WCRC) administration to Capital Bridge, LLC, a small government contactor with 2 employees, for review of Medicare Set Asides (MSAs).  Two other companies submitting bids for the work have protested the award, and CMS has issued a stop work order.

The $60 Million, five year contract would support CMS to independently price future Medicare-covered medical services and prescription drug costs related to Workers’ Compensation injuries, illnesses, and diseases.  It would appear that this is the first time CMS has awarded a prime contract to Capitol Bridge, a SBA 8 (a) certified company.

CMS is currently managing the protests from KEN Consulting, Inc. and Arch Systems, LLC.  The final award is expected to be resolved by mid-December, 2017.  In the meantime, the current WCRC, Provider Resources, will continue to review MSAs that are submitted to them for review and approval. 

Stay tuned for updated information related to this important administrative MSA function as CMS negotiates the future WCRC.  For specific details of the contract and stop work order, please click here >>

MSA RiskPro, a division of Blackburn Group, Inc., designs and creates Lien Verification and Negotiations, Medicare Set Asides (MSAs), Medicare Set Aside Trusts, Medicare Set Aside Accounts, Claim Management and Claim Settlement Solutions. We are recognized by A.M. Best Company as a Recommended Expert Service Provider in the Insurance, Claim Management and Financial industries.

MSA was founded as a specialized Medicare Set-Aside (MSA) insurance claim settlement solutions professional service and product company to address the needs of Workers Compensation and Liability claims under the Centers for Medicare and Medicaid Service (CMS) requirements according to MMSEA Section 111 (MMSEA 111).

What is a Medicare Set Aside? Under Section 1862 42 U.S.C. §1395y(b)(2) and § 1862(b)(2)(A)(ii) of the Social Security Act, Medicare is not responsible for paying a qualified injured person’s medical expenses when payment “has been made or can reasonably be expected to be made under a workers’ compensation plan, an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance.” If the medical expenses are disputed in a personal injury situation, the provider, physician, or other supplier may bill Medicare as the primary payer. If the product or service is normally reimbursable under Medicare rules, Medicare may pay the expenses conditionally. Then if there is a subsequent settlement, judgment, award, or other payment, Medicare requires reimbursement of the expenses. For more information about your unique situation, ask our experts!

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