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HAVE YOU REPORTED YOUR LIABILITY INSURANCE, NO-FAULT INSURANCE, OR WORKERS' COMPENSATION CASE?
The first step in the Medicare Secondary Payer recovery process is reporting your case to the Coordination of Benefits Contractor (COBC). If you have not reported your case, please click here for COBC reporting instructions and contact information.
Don’t Forget!
Once you establish your case with the COBC, you will receive a "Rights and Responsibilities" (RAR) letter from the MSPRC. The MSPRC will then automatically generate a "Conditional Payment Letter" (CPL) within 65 days from the date on your RAR letter. You do NOT need to request the CPL separately.
New Option to Self-Calculate Your Conditional Payment Amount
On February 21, 2012, the Centers for Medicare & Medicaid Services (CMS) will implement an option that allows certain Medicare beneficiaries to self-calculate Medicare's final conditional payment amount prior to settlement. A full explanation, including instructions on how and when to elect this option can be found by clicking here.
The information provided includes eligibility criteria for this process, instructions on how to self-calculate the final conditional payment amount, CMS' review process, tips, and an illustrative example for completing this new process.
CMS will continue to improve and refine this process. Therefore, we welcome your input and comments at a future teleconference.
New Fixed Percentage Option For Medicare's Recovery Claim
Effective November 7, 2011, the Centers for Medicare & Medicaid Services has implemented a new and simple fixed percentage option that is available to certain beneficiaries. This option is available to beneficiaries who receive certain types of liability insurance (including self-insurance) settlements of $5000 or less.
A full explanation, including instructions on how and when to elect this option, is available in the Fixed Percentage Option section of both the Attorney and Beneficiary Toolkits.Beneficiary Alert: $300 Threshold on Liability Settlements
Medicare has implemented a $300 threshold for certain Liability Insurance cases. If all of Medicare's criteria are met, the MSPRC will not recover against the beneficiary's settlement, judgment, award or other payment.
We have posted a detailed explanation in the Attorney and Insurer Toolkits.
Alert: Liability Insurance (Including Self-Insurance) and December 5, 1980 (12/5/1980):
Additional policy details have been provided by the Centers for Medicare & Medicaid Services on liability insurance (including self-insurance) cases involving exposure, ingestion, and implantation.Click here to view the update.
Announcements
January 20, 2010 - January Group Health Plan Demands
The MSPRC will issue Group Health Plan (GHP) Demands on January 25, 2010. Taking insurer workloads into consideration, an insurer may not receive a demand monthly. This process will increase manageability of GHP demands as well as efficiencies in the GHP Recovery Process for insurers, employers, and the MSPRC.
Please refer to the presentation entitled GHP Process Employers and Insurers/TPAs for more information on the GHP Demands, the GHP Recovery Process, and instructions on submitting a valid documented defense.
For information regarding Group Health Plan Demands sent December 31, 2009 click here.
About MSPRC
The Medicare Secondary Payer Recovery Contractor (MSPRC) protects the Medicare trust fund by recovering payments Medicare made when another entity had primary payment responsibility. The MSPRC accomplishes these goals under the authority of the Medicare Secondary Payer (MSP) Act. The MSPRC identifies and recovers Medicare payments that should have been paid by another entity as the primary payer either under a Group Health Plan (GHP) or as part of a Non-Group Health Plan (NGHP) claim which includes, but is not limited to Liability Insurance (including Self-Insurance), No-Fault Insurance, and Workers' Compensation. The MSPRC does not pursue supplier, physician, or other provider recovery.
