CMS Reverses $30K Error Thanks to Expert Rebuttal

Our client received a Determination letter from CMS for $30,000 more than originally allocated. Upon review by our experts, it was clear some amount of the increase was due to recent pricing changes; however, the WCRC made a significant error around the frequency of refills for Naloxone (89 over life expectancy).

Sanderson Firm submitted a successful Reconsideration Request to correct the allocation error, and CMS appropriately recalculated the frequency of the Naloxone nasal spray, which resulted in an amount that was within 5% of the original amount calculated by CMS. Thus, per CMS’ guidelines, they were obligated to approve the original WCMSA amount as submitted.