CMS Announces Transition of NGHP Recovery to Commercial Repayment Center

Currently, Medicare's Benefits Coordination and Recovery Center (BCRC) handles the recovery of conditional payment claims in workers' compensation, liability, and no-fault cases, and the Commercial Repayment Center (CRC) handles the primary portion of the recovery of Medicare payments from group health plans.  CMS recently announced that beginning in October 2015, the CRC will start handling the recovery process in workers' compensation, liability, and no-fault cases when CMS is pursuing reimbursement directly from the primary payer.  The BCRC will no longer handle the recovery of claims from the primary payer but will continue handling the recovery process when CMS is pursuing reimbursement from the beneficiary.

CMS indicated that in the coming months they will schedule webinars and town hall telephone conferences to discuss the transition process.  We will let you know when we receive notice from CMS that any webinars and telephone conferences are scheduled.

CMS also announced that beginning January 1, 2016, "where an insurer or workers’ compensation entity has reported to CMS that it has ongoing responsibility for medicals (ORM) for specific care, CMS’ claims processing contractors will use the information provided by the insurer or workers’ compensation entity to determine whether Medicare is able to make payment for those claims."  CMS reiterated the importance of RREs reporting accurate ICD-9 and ICD-10 codes to ensure that Medicare issues payments appropriately.  Under the current language of the CMS NGHP Section 111 User Guide, RREs are required to start reporting ICD-10 codes for claims with a CMS date of injury on or after October 1, 2015.

For more information visit CMS here.