CMS Releases Bulletin Explaining Delay in Issuance of CPLs, CPNs and Demand Letters


CMS published a Bulletin on February 9, 2016 addressing issues encountered in implementation of Conditional Payment recovery actions against insurers. See bulletin here. According to CMS, the CRC has issued more than 33,000 Conditional Payment Letters (CPLs) and Conditional Payment Notices (CPNs) since the transition. CMS advised that it is aware that many insurers and WC entities are awaiting CPLs, CPNs, or demand letters. CMS has engaged with the CRC to improve responsiveness to requests for conditional payment information and the handling of correspondence.

ExamWorks Clinical Solutions has been working closely with CMS and the CRC to resolve this backlog of requests on behalf of our customers. As the CRC refines its operational processes, insurers and litigants are expected to see an increased volume of recovery actions against insurers as identified debtors in the coming weeks and months. We will monitor any further information from CMS on the issue as well as developments and information that is received as CRC activity is refined.

In October 2015, the Centers for Medicare & Medicaid Services' (CMS) Commercial Repayment Center (CRC) assumed responsibility for the recovery of conditional payments where CMS is pursuing recovery directly from liability insurers (including self-insured entities), no-fault insurer or workers' compensation (WC) entities as identified debtors where Ongoing Responsibility for Medical (ORM) exists.