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Medicare: Just in Time for Valentine’s Day! Medicare: Just in Time for Valentine’s Day!

Medicare: Just in Time for Valentine’s Day!

The Centers for Medicare & Medicaid Services (CMS) recently hosted a conference call to introduce its new Commercial Repayment Center Contractor (CRC), Performant. Beginning Feb. 12, 2018, Performant will handle CMS’ conditional payment reimbursements for worker’s compensation and no-fault recovery claims. The new contractor will continue to assert CMS’ reimbursement interests in settlements with a Medicare beneficiary and follow CMS’ recovery policies. By mid-year, we think this contractor will expand its recovery efforts into liability litigation settlements that appear to shift the responsibility for future medical care to Medicare.

Performant laid out its plan for a smooth transition. Effective Feb. 9, 2018, the existing CRC contractor, CGI Federal, will cease operations as CMS’ conditional payment recovery contractor. There will be a ‘dark period’ from Feb. 8, 2018 to Feb. 12, 2018 while the work and data transitions. Information received during this period will not be processed. After Feb. 12, 2018, there are new addresses and phone and fax numbers to use to contact Performant.

Performant explained during the conference call that its job was to execute existing CMS policy objectives and follow recovery policies. We are optimistic this transition will result in a more efficient and timely review process; however, we continue to urge clients to review the CRC’s conclusions carefully to determine whether the reimbursement requests are appropriate.

Despite the appearance that this is simply a changing of the guard, we think there is a strong likelihood CMS will expand its formal review process to include Liability Medicare Set-Aside (LMSA) and No-Fault Medicare Set-Aside (NFMSA) requirements. We base our position on the fact the RFP for the CRC bids included a provision that gave CMS the discretion to direct its review contractor to begin reviewing certain LMSAs and NFMSAs starting July 1, 2018. All three bids CMS received were significantly higher than the 2012 bid the previous CRC contractor submitted to win for this work. Therefore, in addition to considering Medicare’s potential interests based for reimbursement for conditional payments, parties settling liability or no-fault claims may soon be required to make financial arrangements (a Medicare Set-Aside Agreement) to avoid shifting the responsibility for a claimant’s future medical care to Medicare.

For more information, contact Ann Stewart or another member of our Worker's Compensation Practice.

This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader should consult with legal counsel to determine how laws or decisions discussed herein apply to the reader’s specific circumstances.

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