By Christie Britt, Senior Vice President of Operations, ExamWorks Clinical Solutions
The Commercial Repayment Center (CRC) has been on the job for the last eighteen months. It’s time for a progress report on this contractor, which has reset the timeline for conditional payment investigations.
More recovery collection notices are being issued.
We have seen a slow evolution with the CRC. The CRC began non-group health plan (NGHP) recoveries in October 2015. The CRC’s mandate is simple: recover on Medicare’s behalf whenever a Medicare conditional payment has been made, regardless of settlement, and whenever an insurer has ongoing responsibility for medical bills. For the first four months, the CRC pro- vided few conditional payment notices. Slowly but surely, the CRC provided more information throughout 2016. By the end of the year, the CRC issued more and more recovery collection notices.
Contractors are challenged.
There have been some growing pains as the CRC has gotten its feet wet in the conditional payment space. The CRC sought recovery on claims that appeared unrelated to the workers’ compensation or no-fault claim; issued letters simultaneously with the Benefits and Coordination and Recovery Contractor (BCRC) on the same claims; stopped issuing letters for long periods; and wrestled with disputes and appeals that were new and challenging. These issues materialized at various times from October 2015 to the present. Usually they have been resolved or mitigated quickly, but they still represent major issues for the contractor.
Several challenges remain. It can be frustrating to receive many conditional payment notices or demands that are not anticipated, yet not receive the demand or notice that you have been seeking for several months. The portal has improved in the last six months, but there is often a disparity between what the portal says and what any letter received from the CRC says. We should be able to rely on the portal as a source of information, but the CRC is not there yet.
Use these must practices in handling these cases.
ExamWorks Clinical Solutions’ (ECS) team has been working diligently on these conditional payment issues since the CRC’s arrival on the scene nearly 18 months ago. We are focused on the prompt identification, mitigation, and resolution of these cases, always with our clients’ best interest. We will follow developments with the CRC and work to identify any issues proactively that could impact settlement or resolution, as they arise. For questions about ECS’ conditional payment services, please contact your ECS representative or call 678-222-5300.
About the author
Christie Britt is the Senior Vice President of Operations of ExamWorks Clinical Solutions. She has vast knowledge of Medicare Set-Asides and MSP Compliance. Prior to ECS, Christie worked for a decade in claims management, followed by twelve years in all aspects of MSP compliance. She has developed and enhanced products and operational efficiency models that support growth while ensuring quality. Chris- tie also served as the Director of Financial Operations for Rising Financial Solutions and the Director of Operations for Health Advocates, Inc. PMSI MSA (formerly Helios and now Optum). Christie is MSCC and CMSP certified and has a Green Belt certification in Six Sigma. She is a member of the National Association of Medicare Set Aside Professionals and the Workers’ Compensation Claims Professionals. Christie received a B.S. in Marketing and Economics from the University of South Florida. She earned an M.B.A. from the University of South Florida with disciplines in Healthcare Administration, Quality Management, and Economics.
ExamWorks Clinical Solutions
2397 Huntcrest Way
Lawrenceville, GA 30043