CMS Adds New Provision Regarding the Re-Review Process to WCMSA Reference Guide

CMS Adds New Provision Regarding the Re-Review Process to WCMSA Reference Guide

Recently, the Centers for Medicare and Medicaid Services (CMS) added a new provision to the Workers’ Compensation Medicare Set Aside Arrangement (WCMSA) Reference Guide regarding the Re-Review process. Please continue reading and reach out to MSA Meds today to learn more about the new provision and what it may mean for you. Here are some of the questions you may have:

Previously, what were valid reasons to request a Re-Review?

The existing two valid reasons to request a Re-Review of a submission are missing documentation and mathematical errors. You should note, however, that as per Section 16.2 of the WCMSA Reference Guide, disagreements regarding the inclusion or exclusion of certain treatments/medications do not qualify as “mathematical errors.”

What does the new provision allow?

In addition to missing documentation and mathematical errors, the new provision states that an individual may also request a Re-Review on the basis of submission errors that led to a change in pricing of at least $2,500. In this case, you can submit error-free updated documentation for Re-Review. You should note, however, that this is only available for approvals from September 1, 2022, and on.

What requirements are there?

When submitting amended documents, it’s important to note that they must come from the originators with the corresponding notation to identify where and how the initial error was corrected. The date of correction and a handwritten signature of the correcting individual must also be included. You should also note that Re-Review is limited to one request by type, something that differs from past guidance, which allowed for multiple requests for Re-Review on the same matter.

If you have any questions about the updated Re-Review process or would like to speak with a knowledgeable member of our team here at MSA Meds, simply contact us online or give us a call today. We are here to help you in any way we can.