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.

ELECTRONIC PAYMENTS VIA MSPRP NOW LIVE

Effective April 1, the Medicare Secondary Payer Recovery Portal (MSPRP) is equipped to accept electronic payments for Medicare conditional payment reimbursements. Answers to common inquiries were subsequently released by CMS on April 12, 2019 called “Electronic Payments on the Medicare Secondary Payer Recovery Portal (MSPRP) and Commercial Repayment Center Portal (CRCP) Frequently Asked Questions and Answers.” Such functionality was originally referenced in the Strengthening Medicare and Repaying Taxpayers (SMART) Act of 2012.

In the alert, CMS specifically indicated that to make an electronic payment through the MSPRP, one does not need a new or updated user access. The option is available to any user on any matter to which the user already has access.

Payments are not required to be made through the MSPRP. Payers may continue to remit a paper check to satisfy Medicare conditional payment demands. However, any refund issued by the Medicare recovery contractor will still be made via paper check and will not be made electronically, to date.

Interestingly, CMS specifically reports that in order to make an electronic payment through the MSPRP, the matter to which you wish to apply payment must be in “demand” status. There is no option to remit payment electronically unless the amount has been demanded. Therefore, if payment is desired to be made on a Conditional Payment Notice instead of a Demand for Reimbursement, a written check still must be mailed to the CRC/BCRC for application to the claim. Furthermore, CMS clarifies that when paying online, this does not mean that the full demand amount must be paid. If a Redetermination Request has been submitted on a portion of the conditional payments being asserted, a user can still submit a partial electronic payment.

Finally, CMS reported that the electronic payments utilize Pay.gov to secure the transaction, where payments can be made utilizing a savings/check account, debit card, or PayPal linked to a bank account. Credit cards, however, are not being accepted for payment at present. Also, the limit for each payment method is posted, as well. Once payment has been made. a confirmation of payment will be posted to the MSPRP on the Payment Status page. Additionally, an Electronic Payment History status will list the status of all electronic payments, as well as the amount and payment date.

In summary, the new electronic payment system appears to streamline the payment process significantly, with much quicker application times and updates to the portal. However, as indicated above, it is still requiring that non-demand claims must be paid via paper check. This can be frustrating for those that are attempting to make payments before the demand and can potentially complicate settlements.

We at Gordon and Rees will continue to monitor these issues and will continue to report any updates.