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Posts Tagged ‘Conditional Payments’

This Just In: MSPRC Announces $300 Threshold in Liability Cases

Wednesday, September 7th, 2011

A new alert was posted on the MSPRC.info website on September 6, 2011.  The MSPRC has announced a $300 threshold in liability cases that qualify based on the type of incident and settlement distribution. 

From www.MSPRC.info:

Beneficiary Alert: $300 Threshold on Liability Settlements

Medicare has implemented a $300 threshold for certain Liability Insurance cases. If all of Medicare’s criteria are met, the MSPRC will not recover against the beneficiary’s settlement, judgment, award or other payment.

If you’re a beneficiary, what does this mean for you?

As of September 6, 2011, if you’ve received a lump sum settlement of $300 or less, and your case meets certain conditions, Medicare will not recover from that settlement. These conditions include:

  1. Your settlement is related to an alleged physical trauma-based incident, not an alleged exposure, ingestion, or implantation, and
  2. You do not have any additional settlements related to the same alleged incident.

Please note that this threshold specifically excludes settlements where an insurer is paying your medicals bills directly or on an ongoing basis. This threshold also does not apply if a demand letter was already issued for your case. We have posted a more detailed explanation in the Attorney and Insurer Toolkits.

For more information on the $300 MSPRC Threshold, Medicare Secondary Payer, or any lien resolution issue, feel free to contact Lien Settlement Solutions at info@lienss.com or by phone, (877)907-5436 extension 2. 

We are the Lawyers Solution to Lien Resolution!

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A Timeline for Medicare Lien Resolution with MSPRC

Tuesday, November 2nd, 2010

MSPRC Resolution Timeline*

CMS has revamped the Medicare recovery process, creating a more efficient and less questionable path for the verification of Medicare conditional payments.  Based on a compilation of facts from www.MSPRC.info,  Medicare Correspondence, and daily interaction with MSPRC,  we have created a timeline to a serve as a general guide to the Medicare Resolution Process,  and what can be expected by all parties entering a settlement with a possible Medicare obligation. 

 The following is an approximate timeline for the Medicare recovery process*:

  1. Day 1:  Report to Coordination of Benefits Contractor (COBC) by calling 1(800)999-1118.
  2. Day 2 – 12:  The case is transferred to the Medicare Secondary Payer Contractor (MSPRC) from the COBC within 2 weeks. Read the rest of this entry »

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CMS UPDATE- MMSEA Section 111

Tuesday, August 3rd, 2010

CMS has made the following updates to the MMSEA section of the CMS website:

http://www.cms.gov/mandatoryinsrep/04_whats_new.asp?

August 2, 2010

  • Posted the  Revised – July 30, 2010  NGHP Notice and Agenda For 2010 Teleconferences to the NGHP section page.  This document includes all call in information for these teleconferences.
  • Posted MMSEA 111 – July 12, 2010 – Revised – User Guide – Liability Insurance (Including Self-Insurance), No-Fault Insurance and Workers’ Compensation User Guide, Version 3.1 to the NGHP section page.
  • Transitioned the 2009 NGHP audio transcripts to the Mandatory Insurer Reporting section page.
  • Provided an Opportunity to Comment on Section 111 link on the Overview section page in the Related Links Inside CMS section.
  • Transitioned most of the NGHP alerts to the NGHP Alerts section page.

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CMS UPDATE- MMSEA Section 111

Monday, July 26th, 2010

CMS will be holding an NGHP teleconference on July 28, 2010:

http://www.cms.gov/mandatoryinsrep/04_whats_new.asp?

July 26, 2010

IMPORTANT CALL IN INFORMATION FOR THE JULY 28, 2010 NGHP Teleconference

  • NGHP Teleconference Event – July 28, 2010 (Policy and Technical audio conference)
    • Call In Line:  800-603-1774
    • Pass Code:  Section 111
  • Please begin dialing in approximately 20-30 minutes before the call due to the large number of participants.

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Medicare Secondary Payer Reform… Could it be?

Wednesday, May 19th, 2010

On October 2, 2006 CMS consolidated all conditional payment recovery functions.  CMS transitioned from several recovery contractors nationwide to a single contractor in Chickasaw Nations Industry, LLC. (CNI).  This branch of CNI is the “Medicare Secondary Payer Recovery Contractor” (MSPRC).  Since 2006 the recovery process has improved, but the frustrations involved with resolving Medicare conditional payments still linger.  BUT, could change be coming soon?  A Federal Court Judge has granted action to proceed in a potential class action suit.  The suit will challenge the MSPRC’s recovery procedures.

As explained by Jon L. Gelman:

“The case pending in Arizona questions the authority of the HHS to seek reimbursement in liability claims of conditional payments paid by the Federal government. The plaintiffs are seeking declaratory and injective relief from the HHS procedures. They allege that the HHS has exceeded its authority under the MSP and that the plaintiffs have been denied due process. Read the rest of this entry »

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Revised CMS NGHP Implementation Timetable – Mandatory Reporting

Thursday, April 1st, 2010

CMS has provided an updated implementation timeline for MMSEA Section 111 reporting:

http://www.cms.hhs.gov/MandatoryInsRep/01_Overview.asp#TopOfPage

 • 05/01/2009

Electronic registration via the Section 111 COBSW began for all liability insurance (including self- insurance), no-fault insurance and workers’ compensation RREs (NGHP RREs) excluding foreign RREs.

• 07/01/2009

Test and production Query Input Files accepted for NGHP RREs that completed registration and are in a testing status (the RRE’s signed Profile Report has been received by the COBC).

• 01/01/2010 – 12/31/2010

Claim Input File testing period for all NGHP RREs.  

• 04/05/2010

Electronic registration commences via the Section 111 COBSW for foreign NGHP RREs (those that are based in countries outside the United States and have no Internal Revenue Service-assigned tax identification number and/or US mailing address).

• 01/01/2011 – 03/31/2011

All NGHP RREs must submit initial Section 111 Claim Input production files to the COBC according to assigned file submission timeframes for their RRE IDs.

• 04/01/2011

All NGHP RREs must be reporting production Claim Input Files on a quarterly basis by this date.

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Changes in the MSPRC Conditional Payment Process- Webinar 04/14/2010

Friday, March 26th, 2010
The following Webinar is being provided by the MSPRC regarding the conditional payment and demand process.  The following information has been provided by the MSPRC:

Reserve your Webinar seat now at:
https://www1.gotomeeting.com/register/343904584
 
New changes have been made to the MSPRC Conditional Payment and Demand Process. This Town Hall Meeting will provide education on the New Conditional Payment Notice and Process, as well as updates on:-The MSPRC Recovery Process & Timelines-The Rights and Responsibilities Letter-Proof of Representation vs. Consent to Release-What’s new with the MSPRC      
 
Title:   Changes in the MSPRC Conditional Payment Process for Liability Insurance, No-Fault Insurance, and Workers’ Compensation Cases 
     
Date:   Wednesday, April 14, 2010
     
Time:   1:00 PM – 3:00 PM EDT
 
After registering you will receive a confirmation email containing information about joining the Webinar.

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Medicare Secondary Payer Reform- The Time is Now!

Wednesday, March 10th, 2010

Medicare Secondary Payer Reform – The Time is Now! 

 For the past year, the core objective of the Medicare Advocacy Recovery Coalition (MARC) has been to achieve Medicare Secondary Payer reform.  MARC has been aggressively advocating for improvements to the complex and often unfair Medicare Secondary Payer Act.  MARC is now one step closer to success.  

H.R. 4796, known as Medicare Secondary Payer Enhancement Act of 2010, was introduced in the House by Rep. Patrick Murphy (D-PA/8th District).  This bill was submitted to the House in an attempt to rectify the significant problems with resolution of conditional payments under the MSP Act.  The following is the legislative summary for H.R. 4796 as found on MARC’s Web site: 

Read the rest of this entry »

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MSPRC Hosts Webinar about Lien Resolution Process

Wednesday, February 17th, 2010

On November 12, 2009, the Medicare Secondary Payer Recovery Contractor (“MSPRC”) hosted a webinar titled, ”MSPRC Recovery Process for Liability, No Fault, & Workers Compensation Cases“.   The webinar was moderated by Monique Cooper of MSPRC, along with a few words from Barbara Wright, of the Centers for Medicare & Medicaid Services. 

The purpose of the webinar was to give attorneys a tutorial of the MSPRC/Medicare Recovery process, and to update attorneys on recent changes in Medicare reporting, the addition of the Proof of Representative requirement, changes to the MSPRC.info website, and a brief summary of the Section 111 Mandatory Reporting guidelines by Barbara Wright.  The webinar began with an overview of Medicare’s right of recovery, and a summary of Medicare Secondary Payer and its history.  Medicare is secondary to all liability, no fault and workers compensation insurers when there is a compensable illness, injury or condition requiring litigation or a settlement from a liable third party.  Read the rest of this entry »

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Medicare Denied Claims and Conditional Payments

Thursday, October 29th, 2009

Medicare claim denial is unfortunately a common problem that Medicare beneficiaries are faced with.  Medicare has the highest denial rate of any insurer pursuant to the 2008 National Health Insurer Report Card commissioned by the American Medical Association (AMA, www.ama-assn.org):

  DenialsByInsurer2008[2]

Before we start making hasty assumptions about government health care programs, lets look at some of the reasons why claims have been denied by Medicare.  33.6% of adjustments and 33.7% of denials are due to inaccurate reporting by the providers.  Some of the common billing errors that providers make are: 

Read the rest of this entry »

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