CMS to Host Town Hall on Common Conditional Payment and MMSEA Section 111 Reporting Topics

The Centers for Medicare & Medicaid Services (CMS) recently announced that it will be hosting a Town Hall on April 1, 2021 at 1:00 PM EST to discuss common Medicare Secondary Payer (MSP) conditional payment and MMSEA Section 111 Reporting topics applicable to Non-Group Health Plans (NGHPs). NGHPs are defined by CMS as Liability insurance, No-Fault insurance, and Workers’ Compensation plans.  

The notice states the following:

CMS will be hosting a town hall to discuss common NGHP topics. During this town hall, staff from CMS, the BCRC and the CRC will all be on hand to answer your NGHP related questions. Whether you have questions about Section 111 reporting or about NGHP recovery, this town hall will be beneficial. Questions for this town hall can be submitted in advance to COBR-NGHP-Comments@cms.hhs.gov.

Please have your questions submitted no later than March 25, 2021. Date: Thursday, April 1, 2021 Time: 1:00 PM ET Webinar URL:

https://www.mymeetings.com/nc/join.php?i=PWXW2033201&p=7654759&t=c and Conference Dial In: 888-972-6409 Conference Passcode: 7654759

Commentary: This collaborative Town Hall between CMS, the BCRC, and the CRC is greatly welcomed and appreciated by the NGHP industry. For those that do not work with MSP issues frequently, it is important to understand the various players and their roles with respect to MSP and why this Town Hall will be so helpful to NGHPs.  

CMS directs MSP compliance policy initiatives. The BCRC (Benefits Coordination & Recovery Contractor) primarily drives liability and no-fault conditional payment recoveries, as well as post-settlement conditional payment recoveries in workers’ compensation. The BCRC utilizes MMSEA Section 111 data to maintain the Common Working File (CWF) and manages any coordination of benefits issues as it pertains to Medicare beneficiaries. The CRC (Commercial Repayment Center) works off MMSEA Section 111 data reported by NGHPs to initiate conditional payment recoveries in workers’ compensation and no-fault claims which have reported Ongoing Responsibility for Medical (ORM).

It is extremely valuable that this Town Hall will have representatives present from CMS, BCRC, and CRC as frequently there is an intersection between the BCRC and CRC as it pertains to conditional payment recoveries. It is not uncommon for both the BCRC and CRC to have open conditional payment recovery files open on a particular claim for a multitude of reasons.

For example, during the pendency of a workers’ compensation claim which has been reported as having ORM, the CRC may issue a Conditional Payment Notice (CPN) which requires prompt response and/or dispute. However, once that WC claim settles and a Total Payment Obligation to Claimant (TPOC) notice of settlement is reported via MMSEA Section 111, the BCRC would then take over any additional conditional payment recoveries.

Thus, a workers’ compensation claims payer may receive conditional payment correspondence/demands from both the CRC and BCRC on the same claim. As such, it will be extremely useful for NGHPs to understand the intersection of these entities and additionally for CMS/BCRC/CRC to take questions from attendees.

On a slightly different note, many have been wondering: On the Town Hall, will CMS address the pending Section 111 NPRM on Civil Monetary Penalties which could penalize noncompliant NGHPs up to $1000 per day/per claim? Further, will CMS address the pending rulemaking on Future Medicals and MSP (which would provide guidance on LMSAs and potentially WCMSAs)? More than likely, neither of these rulemakings will be addressed as they are outside of the scope of the Town Hall. However, these remain MSP issues to be watched in 2021 as well as discussed in our Top 3 MSP Predictions for 2021 blog. The new administration’s updated agenda may also have impact on the timing of these rulemakings, once released.

Sanderson Firm will be attending the Town Hall and will follow up with subscribers on any important updates coming out of the Town Hall. Should you have any questions, please contact me at heather@sandersoncomp.com.