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CMS to finalize new expedited conditional payment process

The Centers for Medicare and Medicaid Services (CMS) has announced plans to modify its Medicare Secondary Payer Recovery Portal (MSPRP) to include final conditional payment process functionality by January 1, 2016.

As part of this process, parties will now obtain Medicare’s final conditional payment amount through the MSPRP before settlement, judgment, award, or other payment as required under Section 201 of the SMART Act.

Arnaud Jaegers 253360 Unsplash

Highlights of the new process include the following:

  • To request that the recovery case be part of the final conditional payment process, authorized MSPRP users will notify CMS that a recovery case is 120 days (or less) from anticipated settlement.
  • When the final conditional payment 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 three days of settlement, the beneficiary or a representative will be able to request a final conditional payment amount through the MSPRP.

Once CMS calculates the final conditional payment figure, the amount will remain final so long as:

  • the case is settled within three calendar days of requesting the final conditional payment amount
  • settlement information is submitted through the MSPRP within 30 calendar days of final conditional payment amount request

A copy of the CMS notice can be obtained here.

The planned expansion of the MSPRP is the final piece in implementing the new expedited conditional payment process of the SMART Act. The ability to obtain Medicare’s final conditional payment figure before settlement has been widely heralded as a long-overdue step in the right direction. However, going forward, it will be interesting to assess how workable and practical the new CMS process proves for all stakeholders.

We will continue to monitor developments and provide future updates as warranted. In the meantime, please feel free to contact Mark Popolizio with any questions at 978-825-8186 or email mpopolizio@iso.com.


Mark Popolizio, J.D.

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


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