The scope of conditional payment recovery has changed quite a bit since its inception. The Secondary Payer Compliance guidelines can not only include Medicare, but also Medicaid, Medicare Advantage Plans, and Government and Military Medical Plans. These agencies, now included in Secondary Payer Compliance, are creating subrogation departments or obtaining subrogation contractors to handle the task of recovery. Over the past year, NuQuest has requested liens from agencies and subrogation contractors in all of these areas. We can help in identifying what is required, advise on the differences between a Medicare Advantage Plan and a Medicare Supplemental Plan, and negotiate with these agencies to have unrelated claims removed. In 2015, NuQuest recovered over $2,538,000 for our customers, representing unrelated claims listed on the conditional payment summary.
As of October 1, 2015, Medicare split their Medicare Secondary Payer Compliance unit into two separate agencies. The Benefits Coordination and Recovery Contractor (BCRC) handles all workers’ compensation, liability and no-fault claims developed before October 1, 2015. The Commercial Repayment Center (CRC) handles recovery claims that are directed against the liability insurer, no-fault insurer or workers’ compensation insurer that were developed after October 1, 2015. Needless to say, the transition process in dividing up the work between these two agencies has been a bumpy road. However, we believe that, as the dust settles, communication will improve between the two agencies and the conditional payment process from Medicare will be streamlined.
The Secondary Payer Recovery process and requirements are always in flux. NuQuest strives to stay on top of these changes, keep our customers informed and save our customers from paying for unrelated charges. Our Conditional Payment Coordinators have over nine years of combined experience in the area of Secondary Payer Recovery and Compliance. We are fully versed in authorization requirements and have the ability to procure the latest Conditional Payment information available on the MSPRP Web Portal.
Debra Torchia and Roma DeSanctis.