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CMS Transitions Workload to Commercial Repayment Center

On July 1, 2015, The Centers for Medicare & Medicaid Services (CMS) announced two significant changes during the coming months.  Specifically, CMS will be transitioning a portion of the Non-Group Health Plan (NGHP) recovery workload from the Benefits Coordination & Recovery Center (BCRC) to its Commercial Repayment Center (CRC).

Effective October 2015, the CRC will assume responsibility for the recovery of conditional payments 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 following should be noted regarding the planned workload transition:

•  The transition only includes those cases where CMS is pursuing recovery from the liability insurer, no-fault insurer or WC entity directly.

•  Beneficiaries and their attorneys will continue to work with the BCRC where CMS is pursuing recovery from the beneficiary.

•  Webinars and town halls will be scheduled in the coming months to provide additional information.

Additionally, effective January 1, 2016, CMS will add an additional limitation to Medicare claims payments where insurers or workers’ compensation entities have reported to CMS that they have Ongoing Responsibility for Medicals (ORM). In situations where an insurer or workers’ compensation entity has reported to CMS that it has ongoing responsibility for medicals (ORM) for specific care, CMS’ claims processing contractors will use the information provided by the insurer or workers’ compensation entity to determine whether Medicare is able to make payment for those claims.

Insurers and workers’ compensation entities that notify Medicare that they have ORM are encouraged to report accurate ICD-9 or ICD-10 codes. 

In related news, on May 9, 2014 the President signed into law the Digital Accountability and Transparency Act (DATA Act). One outcome of this legislation will be to reduce the timeframe for the referral of delinquent debt to the Department of Treasury (“Treasury”) for both Non Group Health Plan (including self-insurance, liability, no-fault, and workers’ compensation) and Group Health Plan from 180 to 120 days after the payment is due. This change will become effective October 1, 2015.

For anyone interested in webinar details about the October transition, please click here >>

If you are unable to attend the webinar and would like more information, please contact us and we would be pleased to discuss the changes with you.


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