The Commercial Repayment Center (CRC) took over a portion of the non-group health plan conditional payment recoveries on October 1, 2015. The CRC is charged with recoveries where the identified debtor is the insurance carrier and CMS has been notified via Section 111 reporting of a primary payer. The Benefits Coordination and Recovery Contractor (BCRC) continues to pursue recoveries where the claim is self-reported and the identified debtor is the beneficiary.
It has been no secret that since the CRC has taken over this role, there have been some slight delays in the issuance of Conditional Payment Notices (CPNs) and Demands. CMS issued an alert (click here to view alert) in this regard on February 9th, notifying the industry that the CRC was experiencing delays in the issuance of recovery correspondence, and that CMS was “actively engaged” with the CRC to increase response times.
Clearly, CMS has been effective in increasing the CRC’s responsiveness as Franco Signor has now received a large number of Demands and CPNs as of recent. The Demands are being issued exactly thirty (30) days after a CPN is issued, just as CMS guidance had indicated. These CPNs are being issued on claims where Ongoing Responsibility for Medical (ORM) has been reported by the Responsible Reporting Entity (RRE). A final settlement, judgment or award need not have taken place for the CRC to issue these Demands.
We advise RREs to take note of those claims where ORM is reported and to expect CPNs and Demands where Medicare may have made payments relative to those claims. A key best practice for RREs is to accurately report ICD-9 and ICD-10 codes as these codes influence how CRC searches for WC and NF related conditional payments.
Heather Schwartz Sanderson, Esq., MSCC, CHPE, CLMP, CMSP
Chief Legal Officer
Franco Signor LLC