| As noted earlier in our series, the purpose of reporting such claims to CMS is so that CMS can assure Medicare remains the secondary payer for medical care related to the claim, and recover any applicable conditional payments. 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). If the BCRC determines that the other insurance is primary to Medicare, they will create an MSP occurrence and post it to the Medicare records. If the MSP occurrence is related to an NGHP, the BCRC uses that information as well as information from CMS’ systems to identify and recover Medicare payments that should have been paid by another entity as primary payer. After the MSP occurrence is posted, the BCRC will send the beneficiary a Rights and Responsibilities (RAR) letter. The RAR letter explains what information is needed from the beneficiary and what information can be expected from the BCRC. Please note: If Medicare is pursuing recovery directly from the insurer/workers’ compensation entity, the beneficiary and their attorney or other representative will receive recovery correspondence sent to the insurer/workers’ compensation entity. The BCRC then begins 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). Within 65 days of the issuance of the RAR Letter, the BCRC will send the Conditional Payment Letter (CPL) and Payment Summary Form (PSF). The PSF lists all items or services that Medicare has paid conditionally which the BCRC has identified as being related to the pending case. The CPL explains how to dispute any unrelated claims and includes the BCRC’s best estimate, as of the date the letter is issued, of the amount Medicare should be reimbursed (i.e., the interim total conditional payment amount). The conditional payment amount is considered an interim amount because Medicare may make additional payments while the case is pending. If there is a significant delay between the initial notification to the BCRC and the settlement/judgment/award, the beneficiary, attorney or other representative may request an “interim conditional payment letter” which lists the claims paid to date that are related to the case. The current conditional payment amount can be obtained from the BCRC or the Medicare Secondary Payer Recovery Portal (MSPRP). To obtain conditional payment information from the BCRC, call 1-855-798-2627. 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! Stay tuned for Part V of our MSA Reporting Series – What Happens When A Claim Is Reported After A Case Is Settled? 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! |