MSPRC – Instructions for Electing the New Fixed Percentage Option for Medicare’s Recovery Claim

Medicare Set-Aside Blog on November 7, 2011 | Posted by


The MSPRC has posted the instructions for electing the new fixed percentage option for repayment of conditional payments for certain types of liability insurance settlements of $5K or less.  

Beginning November 7, 2011, a beneficiary who meets the below noted criteria, may resolve their conditional payment lien by paying Medicare 25% of his/her total liability insurance settlement. 



The following criteria must be met in order to elect this option:

The liability insurance (including self-insurance) settlement is for a physical trauma based injury. (This means that it does not relate to ingestion, exposure, or medical implant), and
The total liability settlement, judgment, award, or other payment is $5000 or less, and
The beneficiary elects the option within the required timeframe and Medicare has not issued a demand letter or other request for reimbursement related to the incident, and
The beneficiary has not received and does not expect to receive any other settlements, judgments, awards, or other payments related to the incident.

 
Instructions for electing this option are as follows:



The request for repayment by the fixed percentage option must be submitted at the same time the notice of settlement documentation is provided to the MSPRC.
If the request is made in response to a conditional payment notice (CPN), the request must be received by the response date indicated on the CPN.
A sample request document containing “model language”  for electing the fixed percentage option is available on the MSPRC website.
The request should be mailed to:

MSPRC – Fixed Percentage
PO Box 138880
Oklahoma City, OK 73113
If the request for repayment by fixed percentage is denied, the beneficiary will be provided with an explanation as to the reason for the denial and a final demand letter will be mailed under separate cover.
If the request for repayment by fixed percentage is approved, the beneficiary will receive a bill for repayment of 25% of the total settlement, which must be paid by the timeframe indicated on the letter.


As noted in the prior announcement, in electing this option, the beneficiary will relinquish the right to appeal the fixed payment amount or to request a waiver of recovery for the fixed payment amount.