CMS Alert: New Contractor for NGHP Recoveries and Benefits Coordination in ORM
Heather Sanderson
July 1, 2015

Today, July 1, 2015, CMS issued an alert which states that come October 2015, the Benefits Coordination and Recovery Contractor will be transitioning some of its recovery caseload to a new contractor which will be known as the Commercial Repayment Center (CRC). The CRC will be handling conditional payment recovery where CMS is pursuing recovery directly from a liability insurer (including a self-insured entity), no-fault insurer or workers’ compensation (WC) entity as the identified debtor. The BCRC will continue to handle conditional payment recovery where CMS is pursuing recovery from the Medicare beneficiary.

CMS notes that webinars and town halls will be scheduled in the comings months to provide additional information on this new process.

The alert also provides that come January 1, 2016, CMS will be utilizing ORM information to determine whether Medicare is able to make payment for those claims. CMS further notes that insurers and workers’ compensation entities that notify Medicare that they have ORM are strongly encouraged to report accurate ICD-9 or ICD-10 codes and that Medicare’s claims processing contractors will use this information to pay accordingly.

The alert can be found here: http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Whats-New/Whats-New.html

Franco Signor Commentary: We are hopeful that the transition of some of the workload to the new CRC will streamline the conditional payment recovery process to facilitate quicker settlements. However, with two contractors that will be sharing the conditional payment recovery workload, CMS may be more aggressive in its recovery efforts through these contractors. Additionally, with CMS asserting that it will be using ORM information to coordinate benefits efforts, it is imperative for payers to be accurately reporting claims and their associated ICD-9/ICD-10 codes. We look forward to CMS providing further guidance through its upcoming webinars and town halls.

 

Heather Schwartz Sanderson, Esq., MSCC, CHPE, CLMP, CMSP
Chief Legal Officer
Franco Signor LLC