We all know by now that we have an affirmative duty to notify CMS of the initiation of a third-party liability lawsuit as well as the settlement of that action. Unfortunately it takes an extremely long time to get CMS to provide the amount of its conditional liability payment. A few years ago CMS announced its (delayed) implementation of the Medicare Secondary Payer Mandatory Reporting Provision of the SCHIP Extension Act of 2007, and its intention to require plaintiffs to consider Medicare's interests.
The good news is that CMS is taking steps to make the process easier and quicker for our clients.
If you have not already experienced the change then go to www.msrpc.com to report your case to the Coordination of Benefits Contractor (COBC) and receive your Rights & Responsibilities letter and a Conditional Payment Letter. You can even call the Self-Service Information Line to get demand and conditional payments.
Secondary Payer Act:
You will also want to sign up for the new Secondary Payer Recovery Portal tool to save you time when either contesting the amount of a conditional payment or, uploading settlement documentation.
Medicare Set-Aside Arrangements:
CMS has recently announced a new $300 threshold on liability settlements:
1. the settlement must be related to a physical trauma
2. the liability insurance is $300 or less
3. the client has not received and does not expect to receive any other settlement, and
4. Medicare has not issued a recovery demand letter.
If all criteria are met then CMS will not recover from your client, the settlement, judgment or award.
The website also provides other updated information on how to self-calculate the conditional payment amount as well as when you can use the fixed percentage option for Medicare recovery.
Don't wait until you have a crisis to.call our office at 954-382-1997 to schedule a consultation. Let us counsel you about your options so together we have time to implement a plan so you and your clients have peace of mind.