How does CMS interpret the three-year Statute of Limitations?

On Tuesday, January 14, 2020, the CRC had a Town Hall conference in relation to NGHP recovery. The big news coming out of today’s question and answer segment was how does the three-year statute of limitations apply to recovery efforts by the CRC and BCRC?

According to Tuesday’s Town Hall, it does not apply to CMS contractors recovering on their behalf as this recovery is considered an “administrative” task. CMS’s interpretation of the statute is that the three-year statute of limitations only applies to legal actions brought by CMS (i.e. CMS pursing double damages). Operating under this interpretation of the statute, the CRC and/or BCRC can recovery conditional payments indefinitely.

This is drastically different from the previous stance, as arguments based upon statute of limitations was historically accepted by CMS. Under this interpretation, the CRC or BCRC could potentially attempt to collect on claims that have been closed for more than three (3) years. From a practice standpoint, this could be especially frustrating as Claimants no longer have an incentive to cooperate in the process.

The other aspects of Tuesday’s call revolved around Pre-CPN worksheets and Open Debt reports. While this information is highly beneficial to Responsible Reporting Entities (RREs) the access to these reports is still only available to an RRE’s MSPRP Account Manager. Therefore, one must be the RRE on file in order to access this specific information. To date, this information is not even available to the RRE’s assigned Recovery Agent. Thus, in order for an RRE to obtain this information, you will need to have an account on the MSPRP.

It appears while bringing the portal up to the technologic times, CMS is still restricting access to much of the beneficial information the portal offers and is requiring strict standards in accessing this data.

Another point of interest is what CMS didn’t say about penalties regarding Section 111 reporting. Although it has continually been hinted at being implemented, CMS did not discuss this topic at the Town Hall Meeting. This, however, does not mean that they may not make an announcement in the near future about this issue.

The slides and transcript from Tuesday’s Town Hall should be posted on the CMS website within a few weeks for those that would like to see the entirety of the presentation.

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