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(c) 2016 Jon L Gelman, All Rights Reserved.

Monday, November 9, 2015

CMS Has a New Play Book for Conditional Payments - The Time Factor

The Centers for Medicare and Medicare Services  (CMS) has invoked the element of time to encourage workers' compensation settlements to be finalized. After almost 15 years has lapsed from the Patel Memo of July 11, 2001,  CMS is encouraging compensation claims to be resolved in a timely fashion when conditional payments are at issue.

Recently enacted Federal debt collection legislation has set the tone to encourage repayment of conditional payments in a timely fashion. 

Adding the element of a time deadline in any negotiation results in an acceleration  or resolution. CMS announced today:

"...Upcoming Updates to the Medicare Secondary Payer Recovery Portal (MSPRP) Modification for Inclusion of Final Conditional Payment (CP) Process Functionality"

"As part of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), the MSPRP will be modified to include Final CP process functionality by January 1, 2016. This new functionality will permit authorized MSPRP users to notify CMS that a recovery case is 120 days (or less) from an anticipated settlement and request that the recovery case be a part of the Final CP process.

"When the Final CP process is requested, any disputes submitted through the MSPRP will be resolved within 11 business days of receipt of the dispute. Once all disputes have been resolved, and the case is within 3 days of settling, the beneficiary or their authorized representative will be able to request a Final Conditional Payment Amount on the MSPRP. 

"Once calculated, this amount will remain the Final Conditional Payment Amount as long as:

  • The case is settled within 3 calendar days of requesting the Final Conditional Payment Amount, and
  • Settlement information is submitted through the MSPRP within 30 calendar days of requesting the Final Conditional Payment Amount.