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CMS holds NGHP beneficiary recovery process webinar

On December 9th, the Centers for Medicare and Medicaid Services (CMS) held a non-group health plan (NGHP) beneficiary recovery process webinar. As part of CMS’s webinar notice, the agency noted that the intended audience for this event was “attorneys who represent beneficiaries and other beneficiary representatives.” 

In this sixty-minute session, CMS and its contractor, the Benefits Coordination & Recovery Center (BCRC), discussed several items related to NGHP beneficiary recovery, including the use of the Medicare Secondary Payer Recovery Portal (MSPRP), authorizations, and demand calculation options. Overall, CMS did not announce any new policy changes and used the session to discuss their existing practices and procedures. 

Cp Link

The following provides highlights discussed in this webinar:

Medicare Secondary Payer Recovery Portal (MSPRP)

The BCRC opened the session with a discussion of some of the features and uses of the MSPRP by attorneys and other beneficiary representatives, including the ability of these parties to use the MSPRP for the following purposes:

  • Self-reporting a Medicare Secondary Payer case;
  • Submitting authorizations;
  • Disputing claims;
  • Viewing and printing letters;
  • Submitting settlement information;
  • Initiating a demand letter;
  • Beginning the Final Conditional Payment process;
  • Submitting a waiver, compromise, or redetermination request; and
  • Making an electronic payment.

Also, the BCRC reminded attorneys or other beneficiary representatives interested in registering for an MSPRP account to do so through the MSPRP website. CMS also reminded the attendees that to access some MSPRP features, users may need to have their access authenticated using Multi-Factor Authentication (MFA). Medicare beneficiaries looking to access the MSPRP can do so directly through their account on mymedicare.gov.    

Authorizations

As part of their discussion of the use of the MSPRP noted above, the BCRC indicated that attorneys and other beneficiary representatives could submit authorizations directly through the MSPRP. The BCRC stated a benefit of submitting authorizations through the MSPRP is that they are typically reviewed and authenticated by CMS on the same day, instead of a potential forty-five-day turnaround if the authorization is mailed or faxed to the BCRC.

The BCRC also discussed the two types of authorizations that can be submitted on a BCRC beneficiary debtor case: (i) the Proof of Representation (POR) and (ii) the Consent to Release (CTR). These authorizations have been in use for the past several years. Regarding these authorizations, the BCRC noted the important distinction between the two is a POR allows the authorized entity to represent the beneficiary and act on his/her behalf in terms of disputing and negotiating CMS’s Medicare conditional payment recovery claim. In contrast, a CTR only allows the authorized entity to receive documentation on the Medicare conditional payment case.  

Final Conditional Payment Process and Demand Calculation Options

The BCRC then discussed several alternate methods to obtain CMS’s final conditional payment demand amount, allowing parties to get CMS’s final demand figure before settlement in certain circumstances. The first method noted by the BCRC is the use of the MSPRP to initiate the Final Conditional Payment process as outlined more specifically at 42 U.S.C. § 1395y(2)(B)(vii) and 42 C.F.R. § 411.39. On this point, the BCRC reminded the attendees in general that in certain circumstances, the MSPRP allows authorized users to alert the BCRC that a claim is within 120 days of settlement, and, in that instance, the BCRC then provides a timeline whereby disputes can be resolved during that 120 day period, and a final conditional payment amount can be obtained. For those interested in learning more about the details of this process, please review the above-referenced statute and regulation. Our prior article also provides a general overview. 

The BCRC then discussed two alternate demand calculation options available to parties in certain cases: (i)the Self-Calculated Conditional Payment Amount; and Iii) the Fixed Percentage Option. Under the Self-Calculation option, authorized parties may be able to submit a request for a self-calculated final demand amount to the BCRC in certain physical trauma-based liability settlements with settlement amounts of $25,000 or less, presuming certain criteria are met. Under the Fixed Percentage Option, authorized parties may elect to reimburse Medicare 25% of the settlement amount in settlements involving physical trauma-based liability settlements of $5,000 or less, which meet certain criteria. A detailed review of these options and their related criteria is beyond this article’s scope, but more information can viewed on CMS’s website here for those interested.

CMS's PowerPoint

CMS has released the PowerPoint it used as part of its webinar here

Additional Resource

For additional information on conditional payment updates, see the author’s recent article, Medicare conditional payment round-up – CMS trends, CRC updates, post-settlement TPOC beneficiary recovery and more.

How ISO CP Can Help

Please do not hesitate to contact the author if you have any questions or would like further information on how ISO Claims Partners can help you address your conditional payment claims. We offer several cost-effective and proven compliance solutions to help you stay compliant and reduce your conditional payment exposure, including our programmatic CP Link. In 2019, we saved our clients $110 million in conditional payment disputes and reduced 65% of conditional payment dispute submissions to zero dollars. Our CP Link solution saved our clients over $14 million in 2019 and $11 million so far in 2020. 


Shawn Johnson

Shawn Johnson is legal director at ISO Claim Partners, a Verisk business. You can contact Shawn at shawn.johnson@verisk.com.


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