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In February, 2018, Performant Financial Corporation (parent organization of Performant Recovery, Inc. “Performant”) replaced CGI Federal as the lead contractor in the Commercial Repayment Center (“CRC”) operations. Performant is now responsible for monitoring and collecting any conditional payments which Medicare may have made in Workers’ Compensation claims at the CRC.
Once Performant was able to catch up with the backlog of work from the previous contractor, our team noted the following:
Performant has coordinated with the technology department to take advantage of the MSPRP portal making not only the amount shown on the portal more reliable, but the turnaround time for reviewing authorizations almost instantaneous. There is also an improvement in processing requests for conditional payment and case resolved letters. The MSPRP portal’s addition of a Letter Activity tab is also a useful feature.
1. Performant has coordinated with the technology department to take advantage of the MSPRP portal making not only the amount shown on the portal more reliable, but the turnaround time for reviewing authorizations almost instantaneous. There is also an improvement in processing requests for conditional payment and case resolved letters. The MSPRP portal’s addition of a Letter Activity tab is also a useful feature.
2. There was a period of time where disputes uploaded to the portal were not being processed correctly by the system technology. This resulted in the dispute department being unable to view the dispute images and disputes were closed without being addressed. This issue has reportedly been resolved and we have seen better results with disputes being addressed. There is still, however, some inconsistency in regards to timing of dispute processing, so it is vital that a timely follow up occur while waiting for dispute determinations.
3. The CRC now has cases which may reflect “closed” on the portal, but are in what representatives call “dormant” status. These cases do not reflect Section 111 TPOC or ORM termination dates and have loss dates prior to 10/1/2014. We have been informed that these cases are still in a “searching” status but there is no collection action. Once the Section 111 report gets updated, a duplicate case will open up with a new case number. In practice, this means that we cannot rely on the case “closed” status. If any conditional payments are made, a new case will open unless and until Section 111 ORM termination occurs.
4. We have also seen a drastic increase in the number of duplicative cases being opened up due to issuance of a demand letter. Once a demand letter has been issued, no additional conditional payments will be added to that case. Instead, a second or third case will be opened up with a change in the numbering of the middle grouping of numbers. These cases are now opened almost instantaneously and fairly consistently. In an effort to ensure that all cases have been addressed, if an underlying WC case is nearing settlement, it would be advantageous to perform the “Request Case Access” feature on the portal to make sure you have addressed all open conditional payment cases that may exist.
5. The biggest change we have encountered is Performant’s reliance on Section 111 reporting. Performant uses Section 111 data to open a case to the exclusion of all other reports, including self-reporting. Additionally, Performant will only issue a final demand after Section 111 TPOC reporting occurs. A true final demand will no longer be issued just by uploading an approved settlement contract that closes out medical rights in the claim. Since every Responsible Reporting Entity has a different quarterly timeframe for reporting, this means that there may be up to a four month delay before a final conditional payment demand is made.
6. As of January 7, 2019, the MSPRP portal allows parties to “self-report” a workers’ compensation, liability or no-fault claim. This feature should expedite the ability to initiate the opening of a conditional payment claim when there hasn’t been any Section 111 ORM or TPOC reporting in the claim.
Overall, Performant has made positive strides with conditional payment cases at the Commercial Repayment Center. Although the MSPRP portal is a valuable tool with identifying, negotiating and resolving conditional payment issues, we have found that many times connecting with a representative and dutifully following up has had the most success. Throughout the year, we will continue to follow up and address any issues or changes that occur.