CMS Town Hall Presentation Regarding Commercial Repayment Center Recovery Issues
On January 14, 2020, CMS hosted a Town Hall presentation to discuss issues involving the recovery of conditional payment claims by the Commercial Repayment Center (CRC). The Town Hall included a discussion of the issues below. A copy of CMS’ presentation from the Town Hall is available at https://www.cms.gov/files/document/commercial-repayment-center-crc-non-group-health-plan-nghp-recovery-town-hall-presentation.pdf.
RRE Account Managers have the option to request a pre-CPN worksheet from CRC. The worksheet will list cases that have been reported to CMS and its purpose is to allow RREs to identify potential CPNs that the RRE does not wish to dispute based on the reported data and potential debts owed to Medicare. However, the pre-CPN worksheet will not list the specific charges asserted and is not a platform for addressing disputes with CMS. After the RRE returns the completed pre-CPN worksheet to CRC, CRC is supposed to issue CPNs within the next 90 days.
Requesting a pre-CPN worksheet is entirely optional. Given that the worksheet will not list individual charges and is only intended for RREs to identify cases it does not intend to dispute, its usefulness is limited. Further, RREs that return a completed worksheet to CRC may receive a significant number of CPNs within a relatively short time frame.
Pre-CPN worksheets can be requested once a quarter by the RRE Account Manager. Requests should be sent to firstname.lastname@example.org and should include the TIN and RRE ID(s).
NGHP Open Debt Report
CMS recently made the NGHP Open Debt Report available on the Medicare Secondary Payer Recovery Portal (MSPRP) to MSPRP Account Mangers for insurers and self-insured entities with debts owed to CMS. The Open Debt Report will list all cases where the insurer or self-insured entity is the identified debtor and there is a balance due to CMS. The Open Debt Report is only available to the identified debtor’s MSPRP Account Manager. It is important to note that the MSPRP Account Manager is not necessarily the RRE’s Account Manager, as the MSPRP Account Manager and RRE Account Manager have separate roles. The Open Debt Report lists the Case ID, insurer name, insurer tax ID, RRE ID, Recovery Agent/TPA Name, beneficiary name, claim number, demand letter date, demand amount, current balance, and the current status of the debt.
Statute of Limitations
Given recent statements by CRC that they do not recognize the applicability of the 3 year statute of limitations under the SMART Act, we submitted questions to CMS seeking clarification of their position on the statute of limitations. CMS’ previous CRC contractor would consistently agree to withdraw claims based on the 3 year statute of limitations. However, the current CRC contractor has been ignoring arguments that claims should be withdrawn based on the statute of limitations. In response to our questions, CMS stated during the Q&A session of the Town Hall that their interpretation is that the statute of limitations only applies to lawsuits and does not apply to administrative actions taken by CMS’ recovery contractors. According to CMS’ interpretation, there is no statute of limitations that applies to CMS issuing a demand for reimbursement after a claim is reported under Section 111, even though a 3 year statute of limitations applies to lawsuits. Although CMS recognizes that their ability to recover through a lawsuit is limited by the statute of limitations, CMS’ primary method of collection of unpaid debts is through offsets by the Department of Treasury. Parties seeking to challenge CMS’ interpretation of the statute of limitations would have to present such arguments in the administrative appeals process. After the teleconference, we received an email from CMS indicating that they would respond further to our questions about their position on the statute of limitations. We will let you know if we receive further comments from CMS. If you have any questions about this issue, please let us know.