News

Meet the New Commercial Repayment Center Contractor

Wednesday, January 17, 2018

The Centers for Medicare & Medicaid Services (CMS) and Performant held a joint introductory webinar today, a little more than three months after Performant was announced as the “new” Commercial Repayment Center (CRC) Contractor.  During the one-hour conference call, Performant representatives and CMS laid out the transition plan and fielded questions that they selected from an online queue.  Here are key points all insurers, self-insureds and TPAs need to know:

Don’t Expect Major Policy Changes – Performant explained that its job was to execute on CMS’ policy objectives and that CMS was its client, so it will act in accordance with CMS instructions.  Performant explained that it expected to operate no differently from CGI in terms of the policies, procedures, and timelines.  Performant’s Project Director, Ted Doyle, explained that it would be simply following the recovery policies outlined by CMS.

New Contact Information – Performant and CMS unveiled new phone and fax numbers, as well as a new address.  Here’s the new contact information:

Medicare Commercial Repayment Center
NGHP ORM, PO Box 269003
Oklahoma City, OK 73216
Phone: 855-798-2627 (SAME)
Fax: 844-315-7627 (NEW)

Transition Timeline – CGI Federal will cease operations on Friday, February 9, 2018.  CGI Federal, the existing CRC contractor, will cease operations as contractor at 8 p.m. EST on Wednesday, February 7th.  Performant will commence operations as the new CRC at 8 a.m. EST on Monday, February 12th.  Importantly, Performant will have access to all of the same information as CGI Federal.  There shouldn’t be any information gaps when Performant takes over.

Dark Days – The CRC’s fax line will be turned off on Monday, February 6, 2018 at 8 p.m. ET.  As the timeline above outlines, there will be no “normal” CRC operations on Thursday February 8th or Friday February 9th.  The CRC’s 1-800 line IVR will be turned off at noon ET on February 9th and will not be staffed nor will it take incoming calls.  While the CRC call center will open on February 8th and 9th, the information available to CRC’s representatives will be limited to whatever information existed at the close of business on Wednesday February 7th.  During this time period the MSPRC Portal will have limited functionality and parties will be able to pull information off of the portal but will not be able to push information (such as disputes) to CMS.

Q&A Highlights – The major highlight from the Q&A was CMS’ refusal to rule out changes to the letter of authority process and/or the existing letter of authority language.

What does this mean?

Performant is taking over for CGI Federal, an organization that had the unenviable task of rolling out a brand new conditional payment recovery policy.  CGI Federal was slow to get the program off the ground, perhaps in part because it was attempting to do something that had not been done before in Medicare Secondary Payer recovery.  The transition to a new “ORM Recovery” program was not seamless.  On today’s call, CMS pledged that the transition to Performant would be seamless. 

We are optimistic that the transition will be seamless in terms of the ability to obtain information, the speed and efficiency with which disputes and appeals are reviewed and the willingness to process claims efficiently and expeditiously.   Indeed, we hope that Performant will dramatically improve CGI Federal’s turnaround time to review disputes and appeals and improve call center wait times that often exceed one hour.  With that said, there remain structural challenges to ORM recovery that not only contributes to the volume of disputes and appeals, but also results in a surplus of completely unnecessary recoveries on long gone, hard-to-find, closed claims. 

We are optimistic Performant will prove to be an efficient, helpful, and successful contractor. We remain concerned that CMS is attempting to recover largely on claims for which there is no basis in recovery and for which there is in fact no viable recovery claim available to it.  Simply because an individual once had a workers’ compensation claim, does not mean there should be automatically be a valid recovery claim. 

As we alluded to  in our recent summary on the new User Guide, Medicare’s ORM termination policies limit the reasons and rationale for terminating claims, and result in a tremendous volume of unnecessary recovery claims.  Claims closed five, six, and seven years ago, where ORM cannot be terminated due to Medicare’s policy, look like great recovery claim to the CRC, but almost always result in no recovery to CMS.  For all involved – insurers and self-insureds, CMS and – perhaps most importantly – Performant, Medicare should update its recovery policies to weed out the tremendous volume of pointless recoveries pursued by CRC.

ExamWorks Clinical Solutions will closely monitor this important transition.  For questions about ORM termination, please contact Marty Cassavoy at 781-517-8085 or marty.cassavoy@examworks-cs.com.