What does BCRC mean in CONTRACTORS

A Benefits Coordination and Recovery Contractor (BCRC) is an organization contracted by the Centers for Medicare & Medicaid Services (CMS) to identify potential instances where Medicare might be secondary payer. The BCRC’s primary purpose is to collect repayment from liable third parties when they have provided benefits for services that could also be covered under Medicare.

The role of the BCRC is to coordinate benefits between other insurance providers and Medicare, and to recover funds or payments from other sources when Medicare benefits are primary but another source of payment was mistakenly used first.

CMS provides helpful information on its website regarding how a BCRC works, such as what activities it performs and how those activities are reported. Furthermore, CMS makes available an updated list of the current BCRCs it approves which can be accessed there as well.

Any provider who has billed Medicare for a service that might also be covered by another insurance provider should consider working with the appropriate BCRC to ensure proper coordination of benefits and recovery of payments.

Providers have specific obligations related to ensuring that all claims are paid appropriately, including submitting accurate patient information on claims forms; verifying that payment from other sources has been received prior to billing Medicare; providing updated benefit information upon request; and responding timely to all requests for additional information from a contracting entity such as a BCRC.

No. There is no cost associated with using the services of a BCRC since these firms work on behalf of CMS – any payments recovered are remitted directly back to CMS or other applicable agencies from which funds were previously overpaid or not collected at all.

Providers should only report activity related to coordination and recovery efforts involving their patients through their respective assigned contractor such as their MAC, ZPIC or RAC, FI/Carrier, etc.; specifically designed reports will not result in overpayment repayments being recouped directly from them or their practice(s). Reporting activity through their respective contractors may return money directly back into their practice(s), depending upon circumstances involved with each claim during review or audit processes.

In cases where your Patients have been referred out for secondary payer recovery by your MAC / FI you should receive notification via mail requesting either additional documentation supporting “medically necessary” substantiation for Part B services billed OR requesting you contact/respond within 30 days if you disagree/dispute liability indicated on original claim submission by another payer source; complete instructions detailing how-to respond will be provided in mail along with contact phone numbers & email addresses via toll-free number 1-888-203-1112.

: Not necessarily; referrals may be initiated by various entities such as your MAC / FI , Backlogged Claims Analysts, Zone Program Integrity Contractors (ZPIC), Anti Fraud Contractors (AFCC), Comprehensive Error Rate Testing (CERT), etc., depending upon issue § type being reviewed/audited.

: Issues revolving around possible “medically unnecessary”/ duplicate claims , coordination between payers & beneficiaries , premature billings & collections , incorrect coding issues ; etc., would generally prompt referral scenarios.