P&C companies across the country have been on high alert since October 5, 2015. This date marked the official start of Medicare’s new Commercial Recovery Center program. If you’re still not fully aware of what that means to your company or whether or not you’re prepared to weather that storm, we recommend reading our free ebook today.
The first wave of Conditional Payment Notices (CPN) went out at the end of October. For nearly every insurance company, it’s a matter of when you will receive these letters, not if. We want to make sure you know what to expect. So, here are a few ‘must-knows’ to get you prepared.
What is the CRC’s Conditional Payment Notice?
The CPN you’ll receive from the CRC will look much like its predecessor that came from the BCRC: it’s a rundown of service dates, providers, ICD-10 codes and charges related to a Medicare beneficiary’s medical claims as paid by Medicare, conditionally under the MSP guidelines.
This list of charges may or may not be completely accurate, and may or may not be connected to the casualty claim you’re processing, which means it should be reviewed with a fine-toothed comb to ensure you aren’t paying more than necessary back to Medicare.
The Clock is Ticking
Here is where the new CRC rules begin to deviate from what you’re used to: any dispute must be filed appropriately within 30 days. Upon receipt of the CPN, you’re in a race against time to fact-check Medicare’s charges. If no dispute is received by the CRC within 30 days, the CPN immediately converts to a final demand letter (FDL) and the charges can no longer be easily disputed without a long, drawn out, complex appeals process.
Now, remember: that’s just one CPN. In all likelihood, many will begin coming in, perhaps in bundles. All of them will require a response within 30 days of the date of the letter.
Yes, this is a big deal.
One simple step to make this all “business as usual”:
Without a doubt, this could mean big headaches for you and your claims team. Not only are you facing added stress and cost to handle the volume of letters, but the chance of missing the 30 day deadline, overlooking expensive disputable charges or failing to process disputes properly can put you at risk.
The good news is you do have an option to make this entire headache go away: Contact Flagship Services Group.
Our team of nurses and expert claims handlers will review every CPN to verify the accuracy of each charge and to separate out the charges that aren’t applicable to your claim. We will ensure that you pay Medicare exactly what you owe and not a penny more.
Our procedures – honed over years of concentrating on efficient workflows managing this exact process – give you the best chance of reviewing and disputing claims within the 30-day window so you’re not routinely stuck in drawn out appeals.
What’s more, we’ll stick with the claim until you receive appropriate closure to guarantee 100% compliance with Medicare’s complex requirements.
If you’d like to avoid the headaches and hassles of CPNs and their deadlines, remain compliant, mitigate risk, protect your financial resources, and avoid overpaying on your Medicare liens, contact Flagship and we’ll help you avoid disruption and continue business as usual.