$14K WCMSA Error Reversed by Proving Surgery Was Already Performed

A client received a WCMSA Determination significantly greater than the amount submitted by Sanderson Firm because the Workers’ Compensation Review Contractor (WCRC), improperly included a rotator cuff surgery that was not medically indicated.

Sanderson Firm submitted a Reconsideration Request seeking removal of the surgery as records provided clearly indicated the patient had already undergone a shoulder arthroplasty procedure. CMS removed the surgery and post-operative physical therapy, which resulted in a savings of over $14,000.