16 Dec 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.