CMS Offers Conditional Payment Option Prior to Settlement

CMS Offers Conditional Payment Option Prior to Settlement

The Medicare Secondary Payer Recovery Contractor(MSPRC) announced on its website

that CMS will be implementing an option that will allow certain Medicare beneficiaries to

obtain Medicare’s final conditional payment amount prior to settlement. This is consistent

with its latest announcements establishing a $300 settlement threshold where, if all of

Medicare’s criteria are met, the MSPRC will not recover against the beneficiary’s

settlement, judgment, award or other payment, and its recent implementation

of a fixed 25% option available to beneficiaries who receive certain types of

liability insurance (including self-insurance) settlements of $5000 or less.


The announcement states this new option will be available in February

2012, for certain liability settlements involving physical trauma based injuries

where treatment has been completed. A beneficiary or his representative will now be

allowed to calculate the amount of Medicare’s conditional payments using

information received from the MSPRC, the CMS(MyMedicare) website, or other claims

information available to the beneficiary.


Upon submission of the proposed beneficiary or representative’s

reimbursement calculation, the MSPRC will review the proposed payoff amount

and, after a determination that the amount is “accurate,” will respond with

Medicare’s final conditional payment amount within 60 days. The

announcement makes it clear that in order to secure the final conditional

payment amount, the beneficiary must settle the case within 60 days after the

date of Medicare’s response.