Commercial Repayment Center (CRC) Outreach Program: Getting to know your CRC Operator

Commercial Repayment Center (CRC) Outreach Program: Getting to know your CRC Operator

NuQuest recently met with the operator of CRC, Performant Financial Corporation, as a part of their stakeholder outreach program.  Performant Financial Corporation began operating CRC in February of 2018. More about this can be found here.

At the meeting, CRC provided a presentation regarding their current collection processes and workflows. This post will discuss some of the information and impacts from that meeting.

It is important to understand that in general, a conditional payment estimate letter is not the initiation of collection by Medicare. When Medicare initiates collection, it will send out a “conditional payment notice” or “initial determination.”

The initiation of collection is mostly derived from a carrier or self-insured’s section 111 reporting. Section 111 reporting requires carriers or self-insured to report electronically certain claim information to Medicare, when a claim involves a Medicare beneficiary. This means when a claims manager enters information into their Medicare screens on their system (Settlement, judgement or Ongoing Responsibility of Medical “ORM”), Medicare is using this information to initiate collection.

CRC’s job is to initiate collection against carriers and self-insureds based upon their ORM reporting. CRC is not responsible for the search and collection based upon settlement reporting. If ORM has not been reported and CRC is seeking collection, this information and supporting documentation should be provided to Medicare in defense of the charges.

The Benefits Coordination and Recovery Center (BCRC) is responsible for search and collection based upon settlement reporting. This split in collection duties began in 2015, when CRC first became operational.

What can become confusing at times is that currently, if a carrier/self-insured reports the claim to Medicare, Medicare will sometimes have CRC to search its files and send out the estimate of BCRCs final search. This process is discussed beginning on slide 23 of Medicare’s presentation found here.

With the above background in mind, we can turn to CRC’s presentation:

  • If CRC has issued a conditional payment estimate, it is likely they are providing BCRC’s estimated final lien search.
    • Unless a dispute of the estimate is filed, CRC will automatically search its files and issue an updated conditional payment estimate letter every 35 days until settlement is reported.
    • If CRC is issuing the estimated final lien, BCRC will ultimately complete the final search and initiate collection (if any) once the settlement has been reported.
  • If CRC is issuing a Conditional Payment Notice or Initial Determination to the carrier or self-insured, they are seeking collection based upon the reporting of Ongoing Responsibility for Medical (ORM)
    • This means if ORM has been reported for the low back, arguing low back treatment is unrelated to the claim will generally not be accepted.
      • Medicare may accept the argument, if the parties provide documentation demonstrating the certain dates of service listed in Medicare’s payment summary form are unrelated.
    • Other arguments that the date of service does not require reimbursement may still be viable. (i.e. authorization, dates of service more than three years from request for repayment, etc.)
  • CRC has been initiating collections at a reduced rate while it dealt with transitional issues with prior CRC operator, such as improper referral to U.S. Treasury, etc.
  • CRC anticipates “ramping” up its ORM collections from 150 collections a week to 500 collections per week.
    • This means carriers, self-insured and TPAs should be on the lookout for CRC collection letters and determining if payment and/or if a dispute is viable, more are on the way.
  • CRC encourages electronic payment is made through their Medicare Secondary Payer Recovery Portal, discussed more by CRC here. If sending payment to CRC, be sure to include HICN or Medicare Number and CRC case ID. This will allow Medicare to match the payment properly.

An important takeaway from this meeting is that CRC is relying heavily on the ORM information inputted by claims management teams in its collections. It is important carriers, self-insureds and TPAs are fully aware of the impact this information has with Medicare’s collection.  Ensuring that accurate and specific data is reported to Medicare can minimize extraordinary collections by Medicare.

Please keep in mind that Medicare is anticipating sending out a notice of proposed regulations in September associated with Section 111 reporting. With CRC reliance on ORM reporting, it is hopeful any proposed regulations will assist the stakeholders in complying with Section 111 requirements and should Medicare seek penalties for section 111 reporting violations, the regulations should provide an adequate administrative appeal process.

We will keep you updated as more information becomes available.