There has been a flurry of recent activity from the Centers for Medicare and Medicaid Services (CMS) and the Commercial Repayment Center (CRC) regarding processing of conditional payment claims.
The new CMS and CRC updates, along with their larger claims impact, are outlined as follows:
Open Debt Reports – now available on the MSPRP starting October 7, 2019
CMS has announced in analertdated October 1, 2019 (released on October 3, 2019) that the Medicare Secondary Payer Recovery Portal (MSPRP) will be enhanced on October 7, 2019 to allow for the creation of a real time “Open Debt Report.” Based on the notice, it appears that access and functionality will be limited to MSPRP Account Managers and the report can be generated on-demand. For more technical information please refer to the October MSPRP guide v. 4.7.
This a welcomed announcement by CMS as the Open Debt Report is a tremendous resource for debtors. In the past, the Open Debt Reports provided critical information regarding workers' compensation and no fault NGHP debts that were issued and outstanding with the CRC. On the report, a debtor can see the number of claims, the beneficiary information, the demand dates, the original balance, and the status. In short, it provided a comprehensive overview to identify outstanding debts and a roadmap to resolve them.
Now that access to the Open Debt Report will be provided on-demand and the information is updated nightly, it can be used regularly and efficiently to ensure no outstanding conditional payment debts are missed and helps to minimize the escalation of outstanding debts to the U.S. Department of Treasury. If a debt is listed on the Open Debt Report and it's not currently being resolved, it is an indication that action should be taken. This new resource is an opportunity that we would encourage stakeholders to integrate into their regular conditional payment handling process and protocol for resolving NGHP claims.
We are actively monitoring this development and looking forward to reviewing this MSPRP enhancement. In the interim, please do not hesitate to contact the author if you have questions.
No change to CRC's handling of conditional payment letters (CPLs)
On another front, in our August 22, 2019 blog article we discussed steps that the stated that CRC planned on taking to streamline its workload and complete review of 338,819 open leads pending at the CRC.
Specifically, at that time CRC indicated that it would be moving away from reviewing and responding to fully disputed conditional payment letters (CPL) and, instead, it would only respond to CPLs which had a remaining recoverable amount. Such a change would have been detrimental to debtors because it would have removed a long standing and accepted practice of debtors to proactively ensure that CMS' alleged conditional payments claim was accurate.
However, we were recently advised that CRC will not be implementing this proposed change and that CRC will continue to review, process and respond to all CPLs, regardless of whether fully disputed or partially disputed, in its usual manner. This is welcomed news as it means that debtors will be able to obtain confirmation that fully disputed CPLs are accurate and the CPLs will continue to be an effective first line tool for mitigating potential conditional payment recovery debts.
Pre-CPN worksheets are on hold
The CRC also recently provided an update regarding its release and application of Pre-CPN worksheets. By way of background, the Pre-CPN worksheet is a list of open leads that the CRC has on file associated with an RRE ID. The listed claims exist at a preliminary stage before the CRC reviews the leads, before a CPL or conditional payment notice (CPN) has been issued, and before the claims are considered debts.
In August, the CRC stated that Pre-CPN worksheets would be provided upon request by a debtor. However, it appears that CMS placed the Pre-CPN worksheets on hold pending its review of the process details. Some debtors may have already received the Pre-CPN worksheets prior to CMS' intervention but no further worksheets would be released until the process is approved.
Taking a deeper look into this item, at the time of our August article, the CRC provided the following details regarding Pre-CPNs:
The request and use of the Pre-CPNs worksheet are voluntary.
Pre-CPN worksheets are currently only issued upon a debtor's request.
The Pre-CPN worksheet will likely include duplicates and the CRC is asking the debtors to validate the debts and to review the Section 111 data associated with the open leads.
The Pre-CPN worksheet will contain up to four ICD codes for the debtors to review.
The CRC acknowledged that it will work with the NGHP community on the claim volumes and it is possible to request a smaller Pre-CPN worksheet rather than a complete list of open leads.
The CRC will not currently send less than 25 on a worksheet.
Once a debtor requests a Pre-CPN worksheet the CRC recommends that it should be returned to them in 30 days acknowledging and rejecting leads.
Even if a Pre-CPN worksheet response is not returned by the debtor, the CRC can and will send out CPNs after 30 days for the leads listed on the worksheet.
The CRC will not update, change, or correct incorrect data listed on the Pre-CPN worksheet and the debtor needs to update or correct the data through Section 111 reporting or the BCRC.
The CRC will provide the Pre-CPN worksheet to debtor directly or to a debtor's compliance vendor with a proper consent.
A Pre-CPN worksheet will reflect all open leads.
However, and importantly, as the process is now being reviewed by CMS, some or all the above items may be subject to change.
Pre-CPN Worksheets – Practical Considerations
From a practical perspective, in our previous article we expressed initial reservations regarding the use and effectiveness of the Pre-CPN worksheet - primarily that they would not only unnecessarily trigger and accelerate the CRC issuance of CPNs and demands, but also that the debts would be issued in bulk volumes. It does appear that the CRC is willing to work with debtors regarding the volume of leads which should mitigate that issue, however, the impact still bears watching.
Also, the CRC hasn't yet made clear whether the use of the Pre-CPN worksheet will correct further issues with inaccurate ICD codes and multiple or invalid open leads. We have already raised this issue with the CRC and advised that it would be beneficial if more claim information could be listed on the Pre-CPN worksheet. We will see if the CRC decides to enhance the Pre-CPN worksheet in these respects as we believe it is critical for debtors to have more relevant claim information if it is being used to validate and correct Section 111 reporting data, especially since the CRC indicates that it cannot internally update, change, or correct it at their end.
Going forward, ideally, CMS will address and correct these issues if decides to ultimately Pre-CPN worksheets. However, until that occurs, we still believe that use of the Open Debt Report is a better gauge of outstanding conditional payment exposure and risk since the listed claims on the Open Debt Report are unresolved and active debts. Unlike the Pre-CPN worksheet an Open Debt report provides the number of debts, the demand dates, the original and current balance owed, the status of the debt, the amount of accrued interest, whether an intent to refer letter (ITR) was issue and the date it was issued. As a result, as discussed in the previous section on the Open Debt Report, we would argue that CMS's decision to provide MSPRP Account Managers on-demand access to the Open Debt Report makes the Pre-CPN obsolete when it comes to providing a comprehensive overview of conditional payment claims and a clear roadmap to resolve them.
As previously indicated, what the CRC has proposed or discussed may be subject to change and we will continue to consider the impact to stakeholders as the process evolves.
Disclaimer: WorkersCompensation.com publishes independently generated writings from a variety of workers' compensation industry stakeholders. The opinions expressed are solely those of the author and do not necessarily reflect those of WorkersCompensation.com.