The Commercial Repayment Center (CRC), the national contractor enlisted by the Centers for Medicare and Medicaid Services (CMS) to identify and recover payments mistakenly made by Medicare, doubled its collections in FY2015 from Group Health Plans (GHPs) according to its latest report to Congress. Medicare may make a payment for medical treatment when the insurance information for the plan that should pay first is unknown. These payments are commonly referred to as conditional payments. In those instances, CMS will seek reimbursement for the payments they made on behalf of the Medicare beneficiary.
In FY2015, the CRC identified over $290 million in conditional payments, and collected nearly $150 million of that back on behalf of the Medicare program. All of the CRCs work to date has focused on GHP recovery efforts, however in FY2016, their efforts will expand into Non-Group Health Plans (NGHPs) which include liability, no-fault, and workers’ compensation plans. While a process has always been in place to collect from NGHPs, it can be reasonably assumed that these collection efforts will be much more aggressive and efficient in 2016. Primary NGHP payers should be prepared to properly address the efficiency of these new collection efforts.
Other highlights of the report include:
- The nearly $150 million dollars in net collections represents an increase of nearly 150% in collections over the previous fiscal year.
- Taking into account contractor administrative costs totaling over $24 million, CMS received a return of over $125 million to the Medicare trust fund as a result of the CRCs collection efforts in FY2015.
- The CRC introduced the Commercial Repayment Center Portal, which is a web-based tool that gives debtors a method to electronically manage their debt identification and repayment processes.
To read the report in its entirety, please click here.