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CMS to host town hall meeting to discuss CRC ORM recovery issues related to NGHP claims

The Centers for Medicare and Medicaid Services (CMS) has announced that it will host a telephonic town hall meeting to discuss recovery issues related to the Commercial Repayment Center (CRC) and on-going responsibility for medicals (ORM) with respect to non-group health (NGHP) claims (e.g., liability, self-insurance, no-fault, workers’ compensation, etc.). 

This NGHP Town Hall call is set for January 14, 2020 at 1:00 pm EST. CMS’s notice, which includes call-in instructions and how to submit questions, can be obtained here.

Conditional Payment Updates | Open Debt Reports Are Back; Pre Pcn Worksheets Are On Hold; And Crc Will Continue To Review All Cpl Disputes

While CMS has not posted a specific agenda, there are several challenging issues currently facing NGHP claims payers and practitioners regarding CRC and ORM recovery, including:

  1. Issues caused when a workers’ compensation case is transferred to the BCRC upon a total payment obligation to the claimant (TPOC) (settlements, judgments, awards, or other payments).
  2. What to do when both the BCRC/CRC are both involved in the same claim?
  3. Why is there a difference in the application of the “grouper” algorithm between the BCRC and CRC?
  4. Is the Open Debt Report currently capturing all claims? Also, will access to the Open Debt report be expanded beyond Account Managers authorized to use the Medicare Secondary Payer Recovery Portal (MSPRP)?
  5. Will the CRC continue to use the Pre-CPN report?

It is unknown if CMS plans to address any of these items, which are likely the main interest points to many of the NGHP stakeholders who will attend the call. Our recent article outlines some of these issues in more detail.

ISO Claim Partners will attend CMS’s NGHP town hall and will provide a summary after the call. In the interim, please contact the authors if you have any questions.


Mark Popolizio

Mark Popolizio, J.D., is vice president of MSP compliance at ISO Claims Partners, a Verisk business. You can contact Mark at mpopolizio@verisk.com.

Sid Wong

Sid Wong is assistant vice president of policy at ISO Claims Partners, a Verisk business. You can contact Sid at swong@verisk.com.


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