Medicare Commercial Repayment Center
The Commercial Repayment Center (CRC) will now pursue recovery on claims where the insurer is the debtor: typically No-Fault and Workers’ Compensation claims. This change can leave P&C Insurers scrambling to keep up, but Flagship Services Group is here to help you overcome pending challenges.
Immediate Effects of Reporting via Section 111
Insurers can expect the CRC to review claims reported via Section 111 reporting to determine if conditional payments were made by Medicare that need to be recovered. However, unlike their counterparts at the BCRC, they will not wait for the settlement to be finalized before pursuing reimbursement. As soon as an insurer reports the assumption of ORM, the CRC will investigate whether Medicare has already made payments they believe are related to the claim and send Conditional Payment Notices (CPN). The CRC begins recovery work immediately without waiting for termination of Ongoing Responsibility for Medicals (ORM) or settlement. Accurate Section 111 reporting will be crucial.
Increased Conditional Payment Notices
Based on its audits of reported claims, the CRC will issue a Conditional Payment Notice on every workers’ comp or no-fault claim reported under Section 111 when they have determined Medicare has paid bills related to that claim. The CRC’s focus includes:
- Workers’ Compensation
- Currently, it does not include TPOCs
The Conditional Payment Notice outlines all charges Medicare has paid and expects to be reimbursed. In other words, Medicare will send a bill for every single claim where they should be the secondary payer. You can never assume that all the charges on a CPN are related to the injuries sustained.
Automatic Demand Letters
If a Responsible Reporting Entity (RRE) feels the charges are unrelated, you have only 30 days to dispute the charges. If no dispute is submitted in the 30 day timeframe, the CPN automatically converts to a Final Demand letter (FDL) and interest will start to accrue. This requires RREs to dispute the CPN within a month. If you do not respond within the 30 days, you will possess a FDL.
How Does Flagship Help?
- Flagship has been reviewing and disputing CPNs for several years. We have a proven process to work with Medicare.
- Flagship’s proprietary LumenX claims system ensures that every Medicare-related claim is properly identified, reported, and reviewed for recovery.
- Compliance experts review every Medicare claim to make sure you’re reporting and reimbursing Medicare for everything they are rightfully owed, but not a penny more.
- Our free risk analysis can quickly identify gaps in your compliance process and prevent unnecessary fees.
- How far is too far when negotiating Medicare release terms? (10/7/2019) - At the recent NAMSAP Educational Conference in Baltimore, during a breakout panel discussion on “Leveraging Settlement with Medicare Set-Asides in Mediation”, a rather strident concern was raised with respect to the reasonable scope of terms in a settlement release irrespective of the type of primary plan covering the loss. Specifically, attendees questioned whether Medicare eligible individuals could or to what extent may release their claim or claims in the future to these public health and welfare insurance benefits while negotiating compromise settlement provisions under liability, no-fault or workers compensation plan.
- Treasury Trove (9/17/2019) - Medicare is paid for through two Trust Fund accounts—Hospital Insurance and Supplementary Medical Insurance—held by the United States Department of Treasury, How Is Medicare Funded. In 2018, over 60 million people were covered by Medicare with over $731 billion in total expenditures from the Trust Funds Facts on Medicare Spending and Financing. Further, CMS reports validating $493.68 million in recoverable mistaken conditional payments, while returning $98.68 million dollars to the Medicare Trust Funds in 2018 as a direct result of its recovery program activities, on top of $131.78 million in 2017, MSPRC Commercial Repayment Center in Fiscal Year 2018. Collection activity by the United States Department of Treasury (DOT) on Medicare conditional payments is reportedly increasing in 2019, plus, over the past 15 months, the United States Department of Justice reached six-figure settlements with two Plaintiff’s law firms for failure to repay Medicare conditional payments.
- CMS Favors Professionally Administered Lump Sum MSA (9/5/2019) - Amidst the NPRM chatter on Medicare Set Asides (MSA), with an October action date in the horizon, this is an opportune moment to calmly deliberate on key indicators.