In a previous blog dated September 23, 2011, we announced the confirmation that the MSPRC contract which was previously held by Chickasaw Nation Industries (CNI) would not be renewed when it expired on September 30, 2011 (the contract had been in effect since 2006). CMS confirmed that they would be seeking to establish a centralized Coordination of Benefits (COB) and Medicare Secondary Payer Recovery (MSPR) operation by consolidating the two units. In the interim, Group Health Incorporated (GHI) will be overseeing the recovery process.
On December 8, 2011, CMS posted an RFP (Solicitation Number: RFP-CMS-2011-0048) for an MSP Business Program Operations Contract to establish a centralized operation by consolidating under a single program, the performance of all activities that support the collection, management, and reporting of other insurance coverage of Medicare beneficiaries, and the collection of mistaken primary payments. The intent of the consolidation is to provide quality customer service and a single source to Medicare providers, suppliers, beneficiaries, insurers, and other stakeholders by streamlining the MSP data and debt collection processes while ensuring the integrity of the Medicare Trust Funds.
PMSI believes that the industry would welcome this integration with the hope that it will lead to an improvement in the overall recovery process, particularly the length of time currently involved in verifying and resolving conditional payments. We will continue to monitor the transition as well as the RFP process and will post additional information as it is received.
We have confirmed with CMS that the MSPRC contract which has been held by Chickasaw Nation Industries (CNI) since 2006 will not be renewed when it expires on September 30, 2011. CMS is seeking to establish a centralized and streamlined Coordination of Benefits (COBC) and Medicare Secondary Payer Recovery (MSPRC) operation by consolidating the two units and creating the Medicare Secondary Payer Integration Contractor (MSPIC). CMS posted a source sought notice on August 24, 2011 for the MSPIC. To view this posting click here
In the interim, the MSPRC has confirmed that Group Health Incorporated (GHI) will be overseeing the recovery process and is already on site working through the transition with the MSPRC. It is expected that this transition may be a result of the recent hearing before the Oversight and Investigation Subcommittee in June where the conditional payment recovery process and the administrative fees required to recover debts were called into question. This change could lead to additional administrative and/or policy changes in regard to conditional payment recovery. Changes in the recovery process were initiated earlier this month when the MSPRC announced the implementation of a $300.00 threshold where Medicare will not recover conditional payments for liability claims if certain criteria are met. For additional details on the liability recovery threshold please click here to review our blog post regarding this subject.
PMSI is also hopeful that this transition will lead to an improvement in the length of time it takes to verify and resolve conditional payments which would be welcomed by the industry. We will continue to monitor this transition and post additional information as it is received.