© 2020 Carr Allison Medicare Compliance Group

100 Vestavia Parkway

Birmingham, AL 35216

P: 205.949.2949

F: 205.822.2057

E: mzwilling@carrallison.com

FOLLOW US:

  • LinkedIn - White Circle
  • Twitter - White Circle

 

Required statement from the AL State Bar:  No representation is made that the quality of legal services to be performed is greater than the quality of legal services provided by other lawyers.  Any recoveries and testimonials are not an indication of future results. Every case is different, and regardless of what friends, family, or other individuals may say about what a case is worth, each case must be evaluated on its own facts and circumstances as they apply to the law. The valuation of a case depends on the facts, the injuries, the jurisdiction, the venue, the witnesses, the parties, and the testimony, among other factors.  Disclaimer.

Search
  • Melisa Zwilling

Reminder: Changes to Conditional Payment Claim Recovery Process


As we previously reported, beginning October 5, 2015, the Commercial Repayment Center (CRC) will handle the recovery of conditional payment claims when CMS is pursuing reimbursement directly from the primary payer. The Benefits Coordination and Recovery Center (BCRC) will still handle the recovery process when CMS is pursuing reimbursement from the beneficiary. CMS has indicated that the CRC may pursue recovery from the RRE when ORM has been reported under Section 111 or when the RRE or their representative has otherwise notified CMS that the RRE is responsible for paying for a Medicare beneficiary's treatment. In addition, CMS has indicated that the BCRC will typically pursue recovery from the beneficiary first when CMS is pursuing recovery based on a settlement, judgment, or award. However, if the conditional payment claims remain unresolved by the beneficiary, the CRC could pursue recovery from the primary payer. In general, liability cases should remain unaffected by the new process since they very rarely involve ORM. However, RREs may start receiving conditional payment notices (CPNs) and demands prior to a settlement, judgment, or award in workers' compensation and no-fault cases involving ORM. It is critical for RREs to respond to CPNs and demands in a timely manner. A CPN is not a request for reimbursement. However, a CPN provides a 30 day timeframe to file a dispute before a demand is issued. Once a demand is issued, an appeal must be filed within 120 days of receipt of the demand, and CMS assumes receipt of the demand within 5 days under federal regulations. If an RRE's initial appeal is unsuccessful, the RRE or their representative may continue to appeal conditional payment claims through an administrative appeals process that includes a reconsideration by a Medicare Qualified Independent Contractor, a hearing with an Administrative Law Judge, and review by the Medicare Appeals Council. After all appeals have been exhausted, the RRE may then seek judicial review. If you have any questions regarding the changes to the recovery process, please do not hesitate to let us know.

#CRC #BCRC #RRE #CommercialRepaymentCenter #CarrAllisonMedicareCompliance #CMS

10 views