CMS Names New Workers’ Compensation Review Contractor

The Centers for Medicare and Medicaid Services (CMS) has named a new Workers’ Compensation Review Contractor after some delay. The new contractor, Capitol Bridge LLC, will be reviewing submitted Medicare set aside proposals. The company will price the future medical costs of workers’ comp claims and pass that information to CMS, where it is used to determine if there are sufficient funds set aside for Medicare expenses in the workers’ comp settlements. Capitol Bridge LLC will be replacing Provider Resources Inc., and the switch will most likely cause a delay in getting settlements approved.

Additionally, CMS also released figures for how much it recovered in Medicare conditional payments from primary payers in 2016. At the end of 2015, CMS increased its efforts to recover the expenses for medical bills it has paid to cover the responsible payers. Previously focused on group health, CMS went after both workers’ comp carriers and other non-group-health payers that owed the agency money. While CMS expected a higher rate of recovery with the expanded focus, the amount recovered in 2016 decreased by about $44 million. This decrease could possibly be attributed to group health payers realizing it was best to cover medicals bills before CMS came after them, but the broadened scope could have also served as a hurdle for CMS workers. It seems clear that one of the goals of Capitol Bridge will be to expand the recovery of conditional payments made to those in the workers’ compensation arena as opposed to primarily group health.