Verisk Analytics : CMS Holds Town Hall Call on CRC Transition

On January 18, 2018, the Centers for Medicare and Medicaid (CMS) held its Commercial Repayment Center (CRC) Non-Group Health Plan (NGHP) Town Hall presentation to address the upcoming transition of CRC operations from CGI Federal (CGI) to Performant Financial Corporation (Performant). Performant will assume CRC operations at 8:00 a.m. EST on February 12, 2018.

This call was conducted by: John Albert (CMS), Jacqueline Cipa (CMS), and Ted Doyle (Performant - MSP CRC project director). The panel provided important information and updates on the CRC transition.

The following provides an overview of the CRC and a summary of the Town Hall call as follows:

CRC - Background

In October 2015, CMS introduced the CRC into its recovery process. CMS utilizes the CRC to recover conditional payment claims against claims payers when the payer has assumed on-going responsibility for medicals (ORM). This typically impacts workers' compensation, no-fault, and med-pay claims given the nature of these cases. Under this process, CMS seeks recovery in ORM situation prior to settlement/resolution, which has been a significant departure from CMS' long standing practice of waiting until settlement/resolution to seek reimbursement.

Performant was originally scheduled to take over CRC duties in January 2018. However, CMS delayed this transition to February 8, 2018 and then ultimately pushed it back to February 12, 2018, which is now the official date Performant will take over.

Who is Performant?

Ted Doyle (Performant - MSP CRC project director) provided history on Performant, noting that this company was founded in 1976 and has over 40 years of recovery and collections experience. Most notably, for the past ten years Performant has served as a Recovery Audit Contractor (RAC) for Medicare and a Private Collection Agent (PCA) for the United States Department of Treasury.

Mr. Doyle stated that Performant's goal is a seamless, smooth, efficient, and effective transition. Upon going live, Performant will proactively reach out to industry stakeholders to ensure smooth and optimal operations and will be available for outreach throughout its tenure as the CRC.

Important Transition & Process Updates

Mr. Doyle outlined the following information on the transition and related process items:

1. Performant will maintain the same recovery processes that CGI Federal has been using (i.e. seeking recovery against claims payers in ORM situations)
2. All current case information will be transitioned from CGI to Performant as the CRC
3. Performant will have access to completed case histories, copies of communications, correspondence and contact information, including authorizations
4. All recovery processes, including established timeframes, will remain the same

Transition Timing & CMS' 'Dark Days'

As noted above, Performant will assume CRC operations on February 12, 2018 at 8:00 a.m. EST.

Importantly, CMS advised there will be a 'transition cutover' from February 7-9 (which CMS referred to as 'dark days') where there will be some gaps in availability on case-specific information.

During the 'dark days,' telephone calls will be handled by CGI Federal, but information will only reflect case information that is effective as of close of business February 7, 2018. The Medicare Secondary Payer Recovery Portal (MSPRP) will be available for CRC NGHP cases but will only reflect information as of the close of business February 7, 2018.

As part of this, CMS noted that if payment is due during the 'dark days,' and the CRC receives payment during this period, they will apply the funds retroactively to the debt so that there will be no penalties.

Transition Logistics & Contact Information

Impact

The Town Hall presentation seemed to indicate a status quo of existing processes and procedures with respect to NGHP recovery. Only time will tell if the change to Performant will bring improvements to CMS' new CRC recovery process. Two items to watch here include potential deviation from processes and procedures as well as turnaround times and responsiveness.

In the interim, it is critical that claims payers have sound protocols in place to address Medicare conditional payment claims, and more particularly, CMS' new CRC process of seeing recovery prior to settlement in ORM situations. In ORM situations, the CRC issues conditional payment notices (CPNs) which only provide the claims payers with a 30-day deadline to respond/object. If this deadline is missed, the CPN converts into a demand for payment. This aspect of the CRC process continues to cause many challenges for front line adjusters and claims payers. Constructing proper protocols and education is the key to effectively navigating the new CRC process and optimize opportunities to reduce conditional payment claims.

ISO Claims Partners offers a full suite of services to address challenges posed by the CRC and ORM recovery. It is critical be proactive and leverage Section 111 data to ensure programmatic compliance. Click here to learn more about how CP Link can help navigate ORM recovery.

ISO Claims Partners is closely monitoring all matters related to the CRC transition and will provide industry updates as warranted.

For questions, contact Shawn Deane at [e-mail] or [phone].

Shawn Deane is vice president of product development at ISO Claims Partners where he concentrates on all facets of Medicare Secondary Payer (MSP) compliance. Before joining ISO Claims Partners, he practiced healthcare law and insurance defense. Shawn is a member of the Defense Research Institute, has attained the Medicare Set-Aside Certified Consultant (MSCC) certification, and is the 2017 President of the National Alliance of Medicare Set-Aside Professionals (NAMSAP). He is member of the Massachusetts Bar and is licensed in both state and federal courts in Massachusetts.