New Medicare Secondary Payer Recovery Contract Awarded

CMS, CRC, Medicare Set-Aside Blog, MSP News on October 9, 2017
Posted by Jean S. Goldstein, JD, CMSP

On October 5, the Centers for Medicare and Medicaid Services (CMS) awarded Performant Financial Corporation the Commercial Recovery Center (CRC) contract.  The contract was previously awarded to CGI Federal two years ago, when the CRC expanded and assumed responsibility for conditional payment recovery activities directly from Non-Group Health Plans (NGHPs).

Performant is not a new player in the MSP recovery industry, and currently serves as a CMS Recovery Audit Contractor for Regions 1 and 5; contracts which will terminate on October 31, 2016.  However, under this newly awarded contract, “Performant anticipates staffing the program with over 250 dedicated employees operating out of Performant’s offices around the country.”  With an anticipated staffing increase, this begs the pressing question of whether we will begin to see even more recovery efforts.  In FY 2016, the CRC identified $243.68 million in mistaken payments and posted net collections of $106.29 million on behalf of the Medicare program, as documented in CMS’ annual report.   As we have been advising, recovery efforts by the CRC have certainly increased.  In fact, as reported by CMS, the CRC issued 29,717 demand letter packages relating to 34,406 individual beneficiaries, representing $314.73 million in potential mistaken and conditional payments made by the Medicare program during FY 2016.

With each and every new government award, there is always an implementation period with some unexpected challenges.  However, given Performant’s knowledge of MSP recovery, we hope to only see enhancements and improvements to the MSP recovery process.  As always, we will continue to keep you apprised of all developments during this transition period.