1. Benefits Coordination
and
Recovery Center
(BCRC)
Overview

2. Agenda BCRC Responsibilities BCRC processes
Overview of Data Collections process
Overview of Recovery process
BCRC Contact Info
Call Center
IVR Tips
Virtual Hold
Benefits of BCRC
Questions

3. BCRC Responsibilities
Determining who pays Medicare claims first
Ensuring claims are paid correctly
Sharing Medicare eligibility data with other primary payers
Avoiding duplicate payments
Sending claims data to other insurers
Recover when other insurance should pay first
Purpose of program is to identify health coverage available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken Medicare benefit payments.
Ensure claims are paid correctly, and ensuring the primary payer – Medicare or other insurance – pays first
Sending claims to supplemental insurers for secondary payment (Called “Crossover”) – agreement must be in place between the carrier and insurance company for COB to be automatic – beneficiary must have their supplemental insurance arrange crossover. If no agreement in place – then beneficiary required to coordinate secondary payments with any other insurers.
Making sure that the amount paid in dual coverage situations does not exceed 100% of total claim.

4. How it works BCRC Data Collections Recovery Center
Collects information from multiple sources to research MSP situation.
Section 111 Mandatory Insurer Reporting submissions; Workers Compensation; etc.
Responsible for identifying and recovering Medicare payments that should have been paid by another entity as the primary payer

5. Overview of the Data Collections
Process

6. How Does BCRC Collect Information?
Self Report (Call, Fax, Mail)
Attorney, Beneficiary, Insurer, Provider, etc.
Medicare Secondary Payer (MSP) Claims Investigations
Prescription Drug Coverage Questionnaire
Data Sharing Agreements (DSA)
DSA – Data Sharing Agreement
COBA – Coordination of Benefits Agreement
Mandatory Insurance Reporting (Section 111)
IEQ – Used to collect information about health care coverage that should pay hospital or medical bills before Medicare. Beneficiaries are sent the IEQ approximately 3 before they are entitled to Medicare.
IRS/SSA/CMS Data Match Project – in 1989 Congress enacted a law (Section 6202 of the Omnibus Budget Reconciliation Act of 1989) to provide the Centers for Medicare and Medicaid Services (CMS) with better information about Medicare beneficiaries’ group health plan (GHP) coverage. The law requires that the IRS/SSA and CMS share information that each agency has about whether Medicare beneficiaries or their spouses are working. This is called Data Match.
Under the law, employers are required to complete a questionnaire that requests group health plan (GHP) information on identified workers who are either entitled to Medicare or married to a Medicare beneficiary.
MSP Investigations – Medicare Secondary Payer (MSP) is the term used by Medicare when Medicare is not the responsible for paying first. MSP is sometimes confused with Medicare Supplement. A Medicare Supplement (Medigap) policy is private health insurance policy designed to specifically fill in some of the “gaps” in Medicare coverage when Medicare is primary. Medicare supplemental policies usually typically pay for expenses that Medicare does not pay due to deductibles or, co-insurance amounts or other limits under the Medicare Program.
This MSP Claims investigation activity involves the collection of data on other health insurance that may be primary to Medicare based on information submitted on a medical claim or from other sources.
VDSA – Voluntary agreements allow for the electronic data exchange of GHP eligibility and Medicare information between CMS and employers or various insurers.

7. Overview of the DC Process
Beneficiary, Provider or Attorney calls to report a GHP, NGHP or request information on COB
CSR asks probing questions to determine if beneficiary’s record is accurate

8. Overview of the DC Process
Option 1 – Reporting new GHP record
CSR collects information (SPD, or PDC)
In 24 to 48 hrs. CWF/HIMR system are updated
Confirmation letter is sent to beneficiary

9. Overview of the DC Process
Option 2 – Reporting new NGHP record
CSR collects information (SPD, or PDC)
In 24 to 48 hrs. CWF/HIMR systems are updated
Confirmation letter is sent to beneficiary

10. Overview of the DC Process
Option 2 – Reporting new NGHP record cont.
System forwards all NF and WC leads to CRC
System receives electronic information and creates a Lead
System forwards all Liability leads to BCRC

11. Overview of the Recovery
Process

12. Recovery Process Hospital/doctor submits claim for payment
This is an overview of the recovery process:
A Medicare beneficiary is involved in an accident, incident or illness
Medicare beneficiaries who are injured receive treatment.
The providers will either bill the insurance and we will have no conditional payments to be refunded or they will bill Medicare if payment is not received promptly.
Hospital/doctor submits claim for
payment
Accident/incident/
illness occurs
Beneficiary goes to hospital/doctor

13. Recovery Process Medicare makes conditional payments for services
Case is reported to BCRC and information is gathered
MSP Recovery issues Rights and Responsibilities (RAR) Letter
Medicare will pay the claim conditionally
The incident will also have to be reported, either by self report or section 111 report
Once the incident is reported it is fed from the COB to the Recovery wherein we issue a Right’s and Responsibilities (RAR) Letter to all parties on record who are affiliated with this claim. This letter basically puts the bene on notice that the incident was reported and walks them through their rights and responsibilities to reimburse Medicare.
The payment is “conditional” because it must be repaid to Medicare if/when a settlement, judgment, award or other payment is secured

14. Recovery Process
After issuing the RAR Letter, the search for all claims from the DOI begins
Once all the claims are retrieved they are filtered through by an analyst to determine which claims are accident related and which claims are not and a CPL is issued. The CPL will notify the bene and any authorized entities to date how much money Medicare has paid.
They will review this letter for accuracy and use it to negotiate their settlement.
Medical claims related to the incident are identified and a Conditional
Payment Letter (CPL) is issued
The search for Medicare
Claims begins
Claims may be
disputed from the CPL if recipient feels they are not accident
related

15. Recovery Process Settlement, judgment, award, or other
10. Once a settlement has been reached the bene, or their representative, will submit settlement information (amount, date, fees and costs if applicable)
11. Upon receiving the NOS the Recovery Team will issue a final demand letter requesting payment be made within 60 days of the date of the demand.
Settlement, judgment, award, or other
payment is reached. Notice of Settlement (NOS) must be submitted to the BCRC
The final payment
amount is identified and a Demand Letter is sent

16. A check is received for demand amount
Recovery Process
Option 1 - Payment
There are three possible responses to a demand letter. The first and most favorable is we received a check for the demand amount within the requested timeframe and the file will be closed.
A check is received for demand amount
MSP Case Complete

17. Recovery Process Option 2 – Issues Arise
The second option is post demand correspondence such as:
An Appeal- a disagreement with the existence of an overpayment of with claims on the demand
Waiver- is their request for the entire debt to be forgiven
A Compromise- is their request for a partial amount to be forgiven.
A post demand inquiry is sent.
(e.g. questions, appeals, request for waiver, etc.)

18. Recovery Process Option 3 – Intent To Refer
If Full repayment is not received within 60 days of ITR Letter (120 days of demand), debt is referred to Treasury once any outstanding correspondence is worked
Interest is assessed from date of demand if the debt is not resolved within 60 days
The third and least favorable outcome to a demand is no payment or post demand correspondence is received. if payment is not received then interest will be assessed on the 61st day, and the interest is retroactive . This means that on the 61st day there will already be two months worth of interest on the debt. At that point we also have the ability to send an Intent to Refer (ITR) Letter which advises the debtor they are delinquent in reimbursing Medicare and we will turn the debt over to the Department of Treasury if payment is not forthcoming.
If payment is still not received 60 days of ITR Letter (120 days of demand) then the debt is sent to Treasury once all correspondence has been finalized.
If the debtor is the beneficiary then they risk having their social security or tax returns offset. If the debtor is the insurer then their Tax Identification Number (TIN) will be utilized in offsetting payments.
If full repayment is not received within 60 days, an Intent to Refer Letter (ITR) is issued

19. Contact Information

20. Contact Information
BCRC
Area
Address
MSP
Data Collection
Data Collection Authorization
Data Collections Authorizations
PO Box
Oklahoma City, OK 73113
Medicare MSP General Correspondence
Medicare-MSP General Correspondence
PO Box
Oklahoma City, OK 73113
Medicare MSP Claims Investigation Project
Medicare-MSP Claims Investigation Project
Voluntary Data Sharing Agreement
VDSA Program
PO Box 660
New York, NY 10274
Workers Compensation Set Aside Arrangement Proposal
WCMSA Proposal/Final Statement
PO Box
No change

21. Contact Information
BCRC
Area
Address
Recovery
NGHP Inquiries/Checks/Recovery Authorizations
NGHP
PO Box
Oklahoma City, OK 73113
Fixed Percent Option
PO Box
Special Projects (Product Liability Case inquiries and SP Checks)
Special Projects
PO Box
Oklahoma City, OK 73116
Self Calculated Conditional Payment Option
Self-Calculated Conditional Payment
Overnight Mail – address requests, i.e. subpoenas, checks, etc .
7608 N. Hudson Ave
Raster Master will be removed and only eave BCRC

22. IVR Tips 855-798-2627 First Menu Beneficiary- Press 1
Calling about Beneficiary- Press 2
Commercial Repayment Center- Press 4
Selection must be made at this menu before pressing “0” for an agent

23. IVR Tips Beneficiary Menu 800 Medicare transfer- Press 1
Otherwise Press 2 for BCRC
Complete Authentication via speech recognition (4 pieces)
Successful Authentication
Presented Dynamic Menu based on information on Beneficiary File
Unsuccessful Authentication
Call is transferred to an agent

24. IVR Tips Other Caller Menu Provider- Press 1 RRE- Press 2
Attorney- Press 3
Agent, Other Rep- Press 4
Employer- Press 5
DSA- Press 6

25. IVR Tips Authentication will vary based on caller type
For example Provider/RRE
2 pieces to identify entity
2 pieces for Beneficiary
Successful Authentication
Presented Dynamic Menu based on information on Beneficiary File
Unsuccessful Authentication
Call is transferred to an agent

26. Self Service Information
Coverage Status
Medicare Primary Versus Secondary
Status on Specific Date
Entitlement Information
Date
Reason
ESRD Information
Date of Dialysis
Coordination Period
Recovery Information
RAR Date
CPL Mail Date and Amount
Demand Mail Date and Amount

27. Virtual Hold Call Center offers Virtual Hold
Offers to call back while holding place in the queue
Once called back, agent is ready to assist
Saves time by not waiting on hold
Enhances Customer Experience

28. How BCRC Benefits our Customers
Enhanced Beneficiary experience because claims are processed with greater efficiency due to accurate records
Timelier processing of beneficiaries’ medical claims reduces employers administrative expenses
Physician and supplier’s payments increase when Medicare is secondary payer
Reduces cost of recouping payments made in error and ensures integrity of Medicare Trust Fund

29. Questions?