Conditional Payments

8/16/2016 - 5 min read

Removing impediments to settlements: Conditional payments in liability claims

While liability conditional payments can present some unique challenges, there are effective methods to remove the stumbling blocks to claims resolution.

6/6/2016 - 2 min read

Settlement language strikes again, new case proves clear provisions are critical

Settlement language is an important aspect of Medicare Secondary Payer (MSP) claims that demands careful consideration.

5/27/2016 - 3 min read

Never-ending ORM and what CMS should do about it

The past year has seen tremendous change in Medicare Secondary Payer (MSP) compliance. The Centers for Medicare and Medicaid Services (CMS) introduced rolling recovery to both workers' compensation and no-fault insurance.

5/20/2016 - 4 min read

CMS releases new final rule: Expedited conditional payment process

On May 17, the Centers for Medicare and Medicaid Services (CMS) released its final rule on the SMART Act’s interim conditional payment process through the Federal Register, and insurers will want to become familiar with how this will affect them.

5/9/2016 - 3 min read

Top five tips to get a handle on conditional payments

Conditional payments are one of the biggest challenges insurers face when resolving a case with a Medicare beneficiary.

3/6/2016 - 3 min read

Conditional payments update: Thousands of letters and notices issued

In a brief alert issued on February 11, 2016, the Centers for Medicare and Medicaid Services (CMS) announced that since the October transition of conditional payment recovery from the Benefits Coordination and Recovery Center (BCRC) to the Commercial Repayment Center (CRC), the CRC has issued more than 33,000 conditional payment letters (CPLs) and new conditional payment notices (CPNs).

12/31/2015 - 1 min read

New CMS claims payment process begins January 1, 2016

On December 24, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a reminder that its claims payment process for ongoing responsibility for medicals (ORM) reporting will change on January 1, 2016.

12/29/2015 - 3 min read

CMS releases additional information on the new expedited conditional payment process

On December 21, 2015, the Centers for Medicare and Medicaid Services (CMS) released additional information regarding its continued implementation of the new expedited conditional payment process, set to begin on January 1, 2016.

12/7/2015 - 3 min read

Avoiding the snares of the Treasury Offset Program

When a Medicare conditional payment case is referred to the U.S. Department of Treasury for collection, the Debt Management Services office in Birmingham, Alabama, and their four current Private Collection Agencies (PCAs) begin to collect the referred amount of “delinquent and legally enforceable debt.”

11/19/2015 - 2 min read

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.

11/16/2015 - 4 min read

Eye on the courts: Florida’s collateral source rule does not apply to future Medicare payments

In Joerg v. State Farm Mutual Automobile Insurance Co., 2015 WL 5995754 (October 15, 2015), the Florida Supreme Court ruled that a plaintiff’s eligibility for future Medicare payments is not subject to Florida’s collateral source rule.

7/29/2015 - 1 min read

Employee spotlight: Walter Johnson

With Medicare recovery issues a top priority for our clients, we’d like to introduce you to Walter Johnson, our senior lien analyst.

6/22/2015 - 4 min read

Medicare conditional payment compliance: Myth vs. fact

The statutes and regulations that govern Medicare have been referred to by courts as “the most completely impenetrable texts within human experience.” With the complex nature of Medicare compliance comes the resulting confusion. Don’t fall victim to these Medicare Secondary Payer (MSP) misconceptions.

5/19/2015 - 3 min read

A recipe for confusion: Medicare conditional payment compliance in asbestos-related workers' compensation claims

Medicare conditional payment compliance is difficult enough. When you add complex asbestos-related workers' compensation claims to the mix, it can create a recipe for confusion for insurance carriers, self-insureds, and third-party administrators.

4/15/2015 - 4 min read

Medicare Advantage strikes again: Humana v. Western Heritage

The last few years have seen several key cases regarding the evolving issue of what rights Medicare Advantage organizations (MAOs) have when seeking recovery in a primary payer situation. In particular, MAOs are increasingly seeking federal court — and the Medicare Secondary Payer (MSP) statute’s double damages provision — as the means to recover.