Commercial Repayment Center Updates
The Commercial Repayment Center (CRC) continues to issue Conditional Payment Notices (CPNs) and Formal Demand letters based upon ongoing responsibility for medicals (ORM). In cases where a demand has been issued and the claims are not repaid within the span of a few months, the CRC continues to issue Notice of Intent letters which detail their plan to send any unpaid claims to the Department of Treasury for collection. Unfortunately, we are frequently seeing charges asserted by the CRC that are clearly unrelated to the reported work injuries, are for treatment that was unauthorized, and are comingled with unrelated treatment. As always, we are aggressively disputing and appealing any charges that are not the responsibility of the carrier/self-insured employer. To ensure the best chance for success in disputing/appealing charges asserted by Medicare for your claims, we recommend doing the following:
(1) Make sure the injury information reported under Section 111 for your claim accurately reflects the body parts/conditions established for your claim. If ORM has been terminated, ensure that the termination date has been accurately reported to Medicare.
(2) Ensure that a CPN dispute is filed before the deadline. If a CPN is ignored or if a dispute is not filed timely, one step in the administrative process is lost.
(3) Provide us with any documentation that may be relevant and helpful for disputing/appealing unrelated charges. This documentation could be the first report of injury, medical records discussing the injury or unrelated conditions that the claimant may be receiving treatment for, court orders addressing the carrier/self-insured’s responsibility for treatment, settlement documents evidencing that ORM was previously terminated, etc.
Of course, we are here to help with any questions you may have for your specific claim. Please do not hesitate to contact us.