Good luck with a final conditional payment amount

Medicare Secondary Payer Recovery Portal (MSPRP) will now provide a final conditional payment amount before settlement with a small caveat.

We saw a notice on the CMS website indicating that you can now request a final conditional payment amount before settlement. This sounds like our prayers have been answered but it comes with a big catch!

By way of background, Medicare will make payments for treatment related to a workplace injury even though another party may be responsible under state law. These “conditional payments” must be reimbursed if an individual later receives a settlement or award from workers’ compensation.

Parties have to guess as to the correct lien amount because a final number will not be provided until the case actually settles. This makes resolution extremely difficult because nobody really knows how much needs to be paid back. Not a risk either side wants to take.

We have seen this problem with several of our own clients. They get stuck with larger reimbursement amounts and have no choice but to pay. Many of these individuals had to settle their cases and relied upon bad information from CMS.

Congress passed the SMART Act in 2013 to help address this situation. This legislation was a victory for claimants, employers, and insurance companies. It attempted to fix a problem that everyone agrees existed.

CMS is now implementing the Smart Act through the MSPRP. It attempts to solve the problem by offering an option to obtain final conditional payment information before settlement. Unfortunately, the process creates more bureaucracy and comes with a new set of issues.

Parties are required to settle within 3 calendar days of obtaining the final conditional payment amount. Not exactly a reasonable time frame when dealing with administrative courts and multiple stakeholders. You are unable to request another final conditional payment amount if the deadline is missed.

Everyone agrees that CMS should be paid back for conditional payments. The problem has always been the recovery process. These changes are woefully insufficient and not within the spirit of the Smart Act. We hope the U.S. Congress takes notice and finally insists on a true fix.

Michigan Workers Comp Lawyers never charges a fee to evaluate a potential case. Our law firm has represented injured and disabled workers exclusively for more than 35 years. Call (855) 221-2667 for a free consultation today.

Related information:

Smart Act Passes Both US House and Senate

Photo courtesy of Creative Commons, by casey.marshall.

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