CMS awarded the next Commercial Repayment Center (CRC) contract to Performant Financial Corporation today. The news breaks on the two year anniversary of the launch of the CRC’s ongoing responsibility for medicals (ORM) recovery program. Barring a bid protest the incumbent contractor, CGI Federal, will be phased out over the coming months.
Performant’s press release, explains that it will be staffing the program with “over 250 dedicated employees operating out of Performant’s offices around the country.” Performant will identify and recover payments in situations where “Medicare should not be the primary payer of healthcare claims,” for instance through “employer group health or certain other payers.” As those “certain other payers” know, the incumbent CRC contractor’s pivot to “ORM recovery” from open workers’ compensation and no-fault claims has resulted in a litany of problems for claims payers, the CRC, and CMS.
CGI Federal’s rollout of ORM recovery was slow to get off the ground and, when it did, it was slow to adapt to workers’ compensation and no-fault claims. Simply put, the CRC’s approach all-too-often was built in relation to group health plans. Early on, working with the CRC meant relating certain workers’ compensation and no-fault concepts that many in the industry take for granted. While many of these early hiccups were resolved in part, the CRC program remains a major headache for all the wrong reasons.
Claims payers still see recovery actions initiated on long-dormant claims. Claims payers still see Medicare’s contractor attempt recovery on tens of thousands of dollars for traumatic accidents that occur several years after an inconsequential workers’ compensation claim. These types of recoveries, as well as a host of basic logistical snafus that are often tied to system or training issues, have made dealing the CRC a daily pain point for the workers’ compensation and no-fault community.
We are encouraged that Performant will dedicate 250 employees to the program. However, it remains to be seen what level of resources and system enhancements will be dedicated to the workers’ compensation and no-fault portion of the CRC’s program. Performant’s press release also does not indicate how CMS and the CRC will deal with the “run off” claims prior to the transition to Performant. We would urge CMS and the CRC to learn from prior mistakes, and ensure that there is a solid contractor transition plan in place. Prior transitions, specifically in the Medicare Set Aside realm, have led to significant interruption for claims payers.
ExamWorks Clinical Solutions has been following this procurement closely and will continue to post regular updates as additional information is provide. Contact us about the Commercial Repayment Center and compliance solutions to these thorny issues.
VP Medicare Secondary Payer Compliance
SOURCE: ExamWorks Clinical Solutions