Conditional Payments

11/10/2020 - 6 min read

Medicare conditional payment round-up

CMS has been quite active this year announcing several updates to its Medicare Secondary Payer Recovery Portal and holding a recent webinar on redetermination requests

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10/8/2020 - 2 min read

CMS releases updated Medicare Secondary Payer Recovery Portal user guide

On 10/5/20, CMS released an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide. The changes update the claims listing interface to provide additional functionality.

9/28/2020 - 5 min read

CMS discusses conditional payment issues on NGPH applicable plans webinar

On 9/24, CMS and the CRC held a webinar on redetermination requests as part of the administrative appeals process for conditional payment disputes of non-group health plans.

9/10/2020 - 12 min read

11th Circuit rules Medicare Advantage downstream entities can sue for double damages under MSP’s PCA provision

The 11th Circuit has ruled “downstream entities”, which Medicare Advantage Plans contract with to help provide benefits, can sue primary plans for “double damages.”

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8/25/2020 - 12 min read

U.S. Department of Justice and plaintiff law firm reached a settlement to resolve a Medicare conditional payment claim

The DOJ’s Attorney’s Office for the Middle District of Pennsylvania has settled a Medicare conditional payment claim with the plaintiff law firm.

7/14/2020 - 4 min read

CMS releases updated Medicare Secondary Payer Recovery Portal (MSPRP) user guide (Version 4.9)

CMS has released an updated Medicare Secondary Payer Recovery Portal 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.

6/16/2020 - 9 min read

Key changes to Michigan PIP start July 1, 2020 – Medicare Secondary Payer compliance impact

While individuals will still be able to elect unlimited PIP coverage, for applicable policies issued or renewed after 7/1/20, PIP plans with different coverage limits may also now be purchased.

6/3/2020 - 2 min read

CMS to enhance its MSPRP to allow authorized users to view and print conditional payment correspondence

Starting July 13, 2020, authorized MSPRP users will be allowed to view and print CMS conditional payment correspondence.

5/11/2020 - 23 min read

Court dismisses law firm’s attempt to interplead HHS to resolve Medicare’s conditional payment claim

The United States District Court for the Western District of Missouri in Fowler Pickert LLC v. Glasgow, et. al., 2020 WL 1955266 (W.D. Missouri, April 23, 2020) had to address whether it had proper jurisdiction to determine how much a Medicare beneficiary owed to Medicare from his settlement proceeds in reimbursement of Medicare’s conditional payments

3/30/2020 - 9 min read

Settling claims in unsettling times

In a time of social distancing and uncertainty, many are left wondering how our current working and social paradigm will impact workers’ compensation claims handling – especially being able to close claims.

3/6/2020 - 2 min read

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.

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2/27/2020 - 14 min read

The Eleventh Circuit rules that the MSP’s three-year “claims-filing” statute is not a prerequisite for filing a private cause of action recovery claim

In reversing a lower court decision, the U.S. Circuit Court of Appeals (Eleventh Circuit) in MSPA Claims 1, LLC v. Kingsway Amigo Insurance ruled compliance with the Medicare Secondary Payer’s “claims-filing” statute was not a prerequisite for filing a private cause of action recovery claim.

2/12/2020 - 21 min read

California spotlight: Medicare Advantage recovery rights

The issue of Medicare Advantage Plans recovery rights has catapulted to the compliance forefront over the past few years following a series of court rulings finding that MAPs can sue claims payers for “double damages” under the Medicare Secondary Payer private cause of action provision.

1/21/2020 - 7 min read

CMS holds town hall call to discuss NGHP conditional payment recovery issues

On 1/14/20, CMS held a call to discuss recovery issues related to the Commercial Repayment Center and on-going responsibility for medicals with respect to non-group health claims (e.g., liability, self-insurance, no-fault, workers’ compensation, etc.).

1/10/2020 - 6 min read

Philadelphia law firm reaches settlement with U.S. Department of Justice regarding alleged failure to resolve Medicare conditional payments

The United States Department of Justice (DOJ), United States Attorney’s Office for the Eastern District of Pennsylvania has issued a news release reporting that a Philadelphia personal injury law firm has entered into a settlement for $6,604.59 with the United States to resolve allegations that it failed to reimburse certain Medicare payments made to medical providers on behalf of the firm’s clients.