| The Benefits Coordination & Recovery Center (BCRC) is responsible for ensuring that Medicare gets repaid by the beneficiary for any conditional payments. If an injured worker has Medicare and other insurance coverage, each type of coverage is called a “payer.” When there’s more than one potential payer, there are coordination rules to decide who pays first. Medicare may pay secondary to no-fault insurance, liability insurance or workers’ compensation. To ensure correct payment of Medicare claims, CMS advises Medicare Beneficiaries to always contact the BCRC first whenever they have a pending Liability, No-Fault, or Workers’ Compensation case. According to CMS, this obligation is fulfilled by reporting the case in the Medicare Secondary Payor Recovery Portal (MSPRP) or by contacting the Benefits Coordination & Recovery Center (BCRC). Often in workers’ compensation claims however, CMS is first notified that a Medicare Beneficiary has a workers’ compensation claim when the claim is reported via Section 111 reporting via the Responsible Reporting Entity (RRE) as noted in Part I of our series and/or when an MSA is submitted to CMS for review. Once the case has been reported, the BCRC will collect information from multiple sources to research the MSP situation, as appropriate (e.g., information is collected from claims processors, Medicare, Medicaid, and SCHIP Extension Act (MMSEA Section) 111 Mandatory Insurer Reporting submissions, and worker’s compensation entities). Beneficiaries can access the MSPRP through the Medicare.Gov Web site using their established Login ID and Password for that site. The Web site can be accessed from the link: www.Medicare.gov. Insurers and attorneys will access the MSPRP using the MSPRP Application link: https://www.cob.cms.hhs.gov/MSPRP/. Please note that registration must occur before access to the MSPRP is permitted. Once notified, the BCRC will begin identifying claims that Medicare has paid conditionally that are related to the case, based upon details about the type of incident, illness or injury alleged. Medicare’s recovery case runs from the “date of incident” through the date of settlement/ judgment/ award (where an “incident” involves exposure to or ingestion of a substance over time, the date of incident is the date of first exposure/ingestion). Do you have questions about MSAs, how to value future medical care or posturing your cases for future medical settlement? Contact us for more information! Questions about MSAs, future medical cost projections/life care plans or posturing your cases for future medical settlement? Click here for more information. Stay tuned for Part III of our MSA Reporting Series – Conditional Payments Note: The information contained herein was obtained from CMS and Medicare Secondary Payer resources and is not to be considered legal advice. |
| Our step-by-step process to get MSS working for you couldn’t be EASIER: Use our client portal at medicalsettlementspecialists.com to complete a case intake form and upload documents. On our intake form, tell us your settlement goals (for example, understand the medical exposure, help educate your client regarding their potential risks/benefits of settlement, review an MSA for accuracy, identify non-Medicare covered items, review contested body parts that may be related, etc.) Once you receive your draft report, schedule time to learn the best ways to utilize this powerful TOOL we have built for you! |