The Centers for Medicare and Medicaid Services (CMS) has released an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide (Version 4.9, July 13, 2020). CMS has made multiple updates to the MSPRP, which the agency lists in Chapter I at page 1-1 (Summary of Version 4.9 Updates).
Overall, the updates are aimed at enhancing the MSPRP’s functionality to assist portal users in addressing and processing CMS conditional payment claims. Two new updates likely to be of interest to MSPRP users. They include the ability to download and print outgoing CMS correspondence, viewing when on-going responsibility for medicals (ORM) is applicable, and when an outstanding conditional payment claim has been referred to the United States Department of Treasury.
Regarding these new updates, the authors provide a general summary of the following selected because of likely interest to portal users:
- New Download Capability (CMS Correspondence): MSPRP users will now be able to download and print outgoing correspondence directly from the MSPRP. According to the user guide, this will allow beneficiaries or authorized representatives logged in using multi-factor authentication (MFA) to download a copy of correspondence issued by Medicare’s contractors directly from the MSPRP. (Section 126.96.36.199)
As part of this update, the Letter Activity tab of the Case Information page has been updated to allow users to view and print an outgoing correspondence on the MSPRP. This page now allows beneficiaries or authorized representatives logged in using MFA to click the Correspondence Type to open a PDF of outgoing correspondence using a new Images for Correspondence Type page (Section 188.8.131.52). For example, this will allow beneficiaries or authorized representatives logged in using MFA to download conditional payment notices, demands, and Intent to Refer to Treasury letters, among other correspondence.
The ability to download CMS correspondence could substantially reduce the need to rely on the receipt of mailed correspondence from Medicare’s contractors, thereby saving time and reducing questions which often arise regarding whether contractor correspondence has been mailed.
- Case Information Screen to reflect ORM and Treasury status: The “case information” screen has been updated to reflect when ongoing responsibility for medicals (ORM) is applicable, as well as when the case has been referred to the Department of Treasury for collections. (Sections 14.1 and 184.108.40.206). These updates could also be helpful to users as they will now be able to view ORM information (including an ORM termination date), which can assist in determining potential exposure. In addition, the ability to see whether a claim has been referred to Treasury will help eliminate the guesswork and confusion that can arise in some instances.
- No-Fault/Workers’ Compensation Leads: CMS indicates to prevent beneficiary-debtor cases being created in error, insurers or insurer representatives reporting an MSP no-fault or workers’ compensation beneficiary-debtor lead will be now be required to acknowledge this action before continuing through case creation. (Section 13.1.1). It appears CMS has made this update to ensure only cases eligible are submitted, to avoid duplication of work or cases being created in error.
- MFA Authentication updates (disputes): To improve the dispute resolution process, beneficiaries and authorized users logged in using MFA can now use tooltips when hovering over codes listed on the Claims Listing and Redetermination (First Level Appeal) Submission pages to view descriptions of diagnosis codes, Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) codes, and Diagnosis Related Group (DRG) codes. These pages also now show a list of reported diagnosis codes with the version indicator (Sections 220.127.116.11 and 16.1.3).
In addition to the above updates, CMS has made several other changes of likely lesser significance, including:
- Upload size: CMS notes users should not upload documents with formats larger than 8.5 x 11 inches (Sections 14.1.2, 16.1.4, 16.2.3, and 16.3.3).
- Customer Service Updates: The Forgot Password feature on the Welcome to the MSPRP page now allows users to unlock their account, if locked after three unsuccessful login attempts, or to reactivate an inactive account (Sections 6.3, 6.4, 7.5, and 18.7).
- AMA Copyright: To address a requirement to show the American Medical Association (AMA) copyright notice wherever CPT codes are viewable, a copyright statement has been added to the electronic Payment Summary Form (Figure 14-18) and to the Claims Listing page for beneficiaries and users who log in using MFA (Figure 14-24).
- Requesting Authorizations: Regarding this update, CMS states while it is clear account managers (AMs) and account designees (ADs) can submit or request authorizations for someone else through the MSPRP, the guide has been updated to clarify beneficiaries can do the same when accessing MSPRP through the mymedicare.gov website (Section 18.104.22.168).
Please do not hesitate to contact the authors if you have any questions or would like further information on how ISO Claims Partners can assist you in addressing your conditional payment claims. We offer several different cost-effective and proven compliance solutions to help you stay compliant and reduce your conditional payment exposure, including our programmatic CP Link service. In 2019, we saved our clients $59 million in conditional payment disputes and reduced 65% of conditional payment dispute submissions to zero dollars. So far in 2020, we have saved our client over $25 million in conditional payment disputes.