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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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Author Bio Jeffrey Kaufman

Author
Jeffrey E. Kaufman
Michigan Workers Comp Attorney

Jeffrey E. Kaufman has extensive experience in workers compensation cases and has recovered millions of dollars in benefits for his clients. He believes all injured workers deserve to be on equal footing with insurance companies and employers, and fights tenaciously so their rights are secured and protected.


“Jeff also helped me with getting my Blue Cross bills paid. I would absolutely recommend him and the whole firm. Jeff and the firm did everything they were supposed to do for me and my case.”
Ricardo Perfetto

Hundreds of 5-Star Reviews

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Get Help From our Michigan Workers’ Comp Lawyers Today

You’re not alone. Our Michigan workers’ comp lawyers have been called the best in the state, and our clients love how they’re treated with care, respect, and responsiveness. We will give you the time you need, we will explain your legal rights, and we will always treat you with respect.

Our workers’ compensation and Social Security disability lawyers always put your needs first. Get to know your legal team.

Our attorneys post regularly about common issues related to workers’ comp, including common injuries, settlement calculations, laws, and more.

Injured? It’s Time to Get Some Answers

Don’t let the insurance adjuster push you around. Request your free consultation today.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Our attorneys post regularly about common issues related to workers’ comp, including common injuries, settlement calculations, laws, and more.

Our workers’ compensation and Social Security disability lawyers always put your needs first. Get to know your legal team.