As you know, until now, conditional payment recoveries in non-group health plan, no-fault and Workers’ Compensation injury claims were initiated at the time of settlement.
Starting October 5, with the CMS transitioning recovery to the newly minted CRC, recovery work against insurers will begin prior to settlement.
In addition, the CRC will be specifically pursuing recovery from debtors in situations involving ongoing responsibility for medicals (ORM). They’ll have the authority to look back over an unannounced period of time to review claims reported under Section 111 and immediately demand repayment of conditional payments that have not already been appropriately reimbursed to Medicare.
What do these changes mean to you?
At Flagship Services Group, we’ve been watching intently as this storm developed. It’s been forming on the horizon for a long time, but it’s finally about to hit.
As of October 5, conditional payments will directly impact claims reported for ORM in which settlement is likely to occur, and the CRC will have the ability to pursue recovery far more aggressively than they have in the past.
Between initiating recovery far earlier in the process of current claims and auditing potentially thousands of past claims, these changes can lead to your organization owing Medicare a huge amount of money in a very short period of time.
The more you know, the better prepared you’ll be to weather the storm.
Visit our website and download our free guide, “The Storm is Coming: Preparing for Medicare’s CRC Launch” for all the guidance you need or call me immediately at 774.460.0064.
R. Harrison Ryder, III
Vice President, Sales | Flagship Services Group
11755 E. Peakview Ave. Suite 250 | Englewood, CO 80111
774.460.0064 direct | 774.232.2904 cell