Workers Compensation Review Contractor

The Centers for Medicare & Medicaid Services (CMS), Office of Financial Management, Financial Services Group, Division of Medicare Secondary Payer Program Operations, has responsibility under the Medicare Secondary Payer (MSP) provisions of the Social Security Act Section 1862(b) [42 U.S.C. 1395y] to protect Medicare's interests by making sure that Medicare pays correctly and recovers payments when it has paid conditionally or mistakenly. The MSP provisions, in part, prohibit Medicare from making payment where payment has been made. This includes situations where individuals receive workers' compensation settlements, judgments, awards, or other payments (hereafter known as settlement). In order to make sure that Medicare does not pay for care related to the workers' compensation settlement, CMS maintains a voluntary process that allows individuals and entities to submit proposed amounts, for CMS review, that will protect Medicare's interest with respect to future medical care related to the workers' compensation settlement. A CMS approved WCMSA amount is used to pay for future Medicare covered and otherwise reimbursable items and services that are related to the workers' compensation settlement. Once the amount is appropriately exhausted, Medicare will continue to pay for related care, as appropriate. To reduce the time associated with proposed WCMSA amount review and evaluation, and enhance the level of associated customer service, CMS is seeking to retain a Workers' Compensation Review Contractor (WCRC). The WCRC is an independent entity that determines if proposed WCMSA amounts submitted to CMS for approval adequately protect Medicare, so that Medicare does not pay for related future medical care, including prescription drugs.