Automated CP Compliance

Streamlining the conditional payment process and reducing costs

Automated CP Compliance from ISO Claims Partners is the most cost-effective and streamlined way to handle Medicare conditional payments. The service lets you expedite conditional payment negotiations with the Centers for Medicare and Medicaid Services (CMS) — and it assures correct, consistent handling every time. You’ll save time and reduce conditional payment amounts while ensuring compliance with Medicare laws and regulations.

Background

In 2012, the CMS introduced its Medicare Secondary Payer Recovery Portal (MSPRP) — a web-based tool designed to help resolve conditional payment cases. The portal has limitations, but ISO Claims Partners has developed a proprietary approach to overcome those limitations. We streamline the process using data from your Section 111 reporting. A specialized workflow results in increased claims-handling efficiencies, dramatic cost and time savings, and an improvement in overall compliance.

How it works

ISO Claims Partners can tailor the process to fit your specific needs. For example:

  • If you use our MSP Navigator® for Section 111 reporting, we get your data directly from that feed.
  • Alternatively, we can integrate with your claims system for an automated data feed.
  • Or we can arrange scheduled manual transmission of claims data.

Once you’ve transmitted the data on a claim, Automated CP Compliance immediately registers it — through an expedited process — with the Coordination of Benefits Contractor (COBC) and sets it up with the Medicare Secondary Payer Recovery Contractor (MSPRC). ISO Claims Partners quickly gets all data needed to access conditional payment information and conduct activities with the MSPRC.

Time savings

With Automated CP Compliance, you cut weeks off every activity needed to resolve a conditional payment case. Here are the typical time savings compared with manual methods.

Activity Time with Manual Methods Time with Automated CP Compliance
Proof of representation and consent to release verification 21 days 1–7 days
Requesting updated conditional payment amount 45 days 1–3 days
Requesting updated conditional payment letter 45 days 21 days
Conditional payment dispute 45–65 days 0–40 days
Submission of settlement information to trigger issuance of final demand 45–65 days from submission of settlement documents 20 days from uploading settlement information

Cost mitigation

Automated CP Compliance further speeds the conditional payment process by addressing Medicare “liens” according to your established protocols and thresholds at every decision point. You set the rules and dollar thresholds for such decisions as disputing or negotiating a conditional payment amount, and Automated CP Compliance eliminates virtually all the compliance guesswork. You get enhanced program efficiency and consistency and reduced costs.

ISO Claims Partners has cost mitigation for conditional payments down to a science. Our data suggests that our automated approach to disputing conditional payment amounts can yield a savings of about 83 percent per claim compared with CMS’s initial demands. For every 500 conditional payment letters, primary payers face some $3.1 million in conditional payment exposure. So, a systematic approach — capitalizing on the proven savings from Automated CP Compliance — could give a substantial boost to your bottom line.

For more information about ISO Claims Partners Medicare compliance services

Representatives are available Monday through Friday, 9 a.m. through 8:30 p.m. Eastern time.