Earlier this month, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited update and clarification on the conditional payment process for the Medicare Secondary Payer Recovery Portal (MSPRP or Recovery Portal). This is a significant development for us and our clients and the broader community of the plaintiffs’ bar because it affects the timeline and best practices that should be followed in resolving any case where Medicare has rights to receive reimbursement from the settlement proceeds.
CMS has been working for several years now to develop the Recovery Portal as a means for expediting the resolution of Medicare lien claims. Chronic delay from the Medicare bureaucracy in determining the final reimbursement amount has long been a cause of considerable frustration for plaintiff’s attorneys.
According to the announcement earlier this month, CMS has indicated that it is on-track to launch the new functionality to the MSPRP by January 1, 2016. This new functionality is designed to “permit authorized MSPRP users to notify CMS that a recovery case is 120 days (or less) from an anticipated settlement and request that the recovery case be a part of the Final CP process.” By making a request for a Final CP process, it will trigger resolution of the final claim amount in accordance with the following timeline:
- Once the Final CP process is requested, any disputes submitted through the MSPRP will be resolved within 11 business days of receipt of the dispute.
- Once all disputes have been resolved, and the case is within 3 days of settling, the beneficiary or their authorized representative will be able to request a Final Conditional Payment Amount on the MSPRP.
- Once calculated, this amount will remain the “Final Conditional Payment Amount as long as the case is settled within 3 calendar days of requesting the Final CP amount, and settlement information is submitted through the MSPRP within 30 calendar days of requesting the Final CP amount.
For those of you who are unfamiliar with the CMS claims administration process and all the jargon and acronyms that go along with it, take it from us that this is a good thing. Assuming that Recovery Portal functions as promised, this will put plaintiff attorneys in a much better position to have a good handle on liens prior to settlement, and to get paid and distribute funds after settlement in a much more timely fashion.