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CMS releases town hall question/answer document

The Centers for Medicare and Medicaid Services (CMS) has released a question/answer document in follow up to its January 14, 2010 town hall call.

By way of background, CMS’s January Town Hall focused on conditional payment recovery issues related to the Commercial Repayment Center (CRC) and on-going responsibility for medicals (ORM) with respect to non-group health (NGHP) claims (e.g., liability, self-insurance, no-fault, workers’ compensation, etc.). CMS previously released its presentation slides as part of this event. Our town hall article also provides a summary of the items addressed in the January call. 

In this new resource, CMS has now compiled, as it states, a set of “answers to commonly asked questions from the CRC NGHP Recovery Town Hall.” Overall, a total of fifteen (15) questions/answers are addressed in the document, with CMS also providing links to related resources to certain questions.

Several important issues related to CMS’s conditional payment process are outlined in this new resource. For example, CMS provides general information about its NGHP recovery process in Q/A Nos. 1 and 2. In Q/A No. 4, CMS discussed how Conditional Payment Letters (CPL) and Conditional Payment Notices (CPN) become final demands; while Q/A No. 8 discusses appeals. In addition, CMS addresses items related to Treasury Claims in Q/A Nos. 6, 7, and 9. What happens with CRC/ORM debt is addressed in Q/A No. 3. Information on how to make payment on a CRC NGHP debt is addressed in Q/A No.10.

One item of note is Q/A No. 12 which addresses the Medicare Secondary Payer’s (MSP) three-year statute of limitations (SOL) per 42 U.S.C. § 1395y(b)(2)(B)(iii). This section provides, in pertinent part, that “[a]n action may not be brought by the United States under this clause with respect to payment owed unless the complaint is filed not later than 3 years after the date of the receipt of notice of a settlement, judgment, award, or other payment made pursuant to paragraph (8) relating to such payment owed.”

While acknowledging this provision, CMS in its answer to question #12 also states that “[t]his statute of limitations does not prevent CMS from utilizing administrative or other non-judicial methods of collecting on or requesting payment for a debt, short of filing suit or otherwise bringing an action in state or federal courts.”  On this point, CMS during the town hall call appeared to take the position that the MSP’s three-year SOL only applied to CMS’s ability to bring formal legal actions but did not apply to its administrative or non-judicial debt collection activities. While complete examination into the MSP’s SOL is beyond the scope of this article, CMS’s apparent position raises the obvious concerns that, at least from its view, its collection activities outside of the filing of a formal legal action are not limited by the three-year SOL.

If you have any questions, please do not hesitate to contact the author.  

Explore how ISO Claims Partners is well equipped to help you address your conditional payment claims, Treasury actions, and Medicare Advantage recovery claims here.

Mark Popolizio, J.D.

Mark Popolizio, J.D., is vice president of MSP compliance, Casualty Solutions at Verisk. You can contact Mark at

Sid Wong, J.D.

Sid Wong is the Vice President of Policy at Verisk Casualty. In this capacity Sid monitors and evaluates the changing state of Medicare Secondary Payer compliance to develop impactful solutions to emerging MSP issues and works to ensure that Verisk’s Casualty’s policies, products, and services continue to align with the MSP landscape. He also oversees Verisk Casualty’s policy team, which provides policy and compliance support for all of Verisk Casualty’s clients. During his tenure he has served as Legal Director, Assistant Director of Services, Client Solutions Manager, and MSP Compliance Manager. Sid is a subject matter expert on MSAs, Conditional Payment Recovery, and Section 111 reporting. He collaborates with clients to develop best practices and respond to any compliance or policy questions, whether it’s a case level issue or evaluating a process impacting the larger organization. He regularly presents at industry conferences and provides training for clients.

Prior to joining Verisk, Sid worked for a small general practice firm in New Hampshire where he received his JD from University of New Hampshire Franklin Pierce School of Law. Sid is a member of the MA, NH, and NY bar, the IAIABC, NAMSAP, MARC, and is MSCC certified.

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