Enhanced Functionality and Other Changes to the Medicare Secondary Payer Recovery Portal as of January 1, 2016

CMS, Conditional Payments, Mandatory Insurer Reporting, Medicare, Medicare Set-Aside Blog, MSP News on January 6, 2016 | Posted by Erin O'Neill, PA-C, JD

As of January 1, 2016, the Medicare Secondary Payer Recovery Portal (MSPRP) now includes functionality for obtaining a final conditional payment amount on those cases that are 120 days or less from an anticipated settlement. These changes were implemented as part of the Strengthening Medicare and Repaying Taxpayers Act of 2013.

Authorized users are now able to notify CMS that a settlement is pending and request that the final conditional process be initiated utilizing the MSPRP. Any disputes regarding relatedness, submitted through the MSPRP, will be resolved within eleven days. Once any disputed charges have been resolved and the case is within three days of settling, a final conditional payment amount may be requested utilizing the MSPRP. This amount will remain the final conditional payment amount as long as the case settles within three days and the final settlement information is submitted through the MSPRP within thirty days.

The request for a Final Conditional Payment amount can only performed once per case. If the case does not actually settle within three days or if the final settlement information is not submitted within thirty days, then the process will be voided and additional conditional payments may be added and the Final Conditional Payment Amount may change.

CMS has also indicated that the Final Conditional Payment Process can be initiated by an insurer or their authorized representative on an insurer-debtor case, as long as no outstanding Ongoing Responsibility for Medicals (ORM) exists and as long as settlement is pending. Once the process is initiated, the insurer-debtor case will be closed and the outstanding conditional payment amount will be transferred to a new case where the beneficiary will be then be identified as the debtor. Of importance, in order to receive copies of any correspondence related to the new case or to discuss the case with the BCRC/CRC, the insurer/authorized representative would now need to obtain an authorization signed by the beneficiary.

The announcement can be viewed on the Coordination of Benefits and Recovery Overview What’s New page on CMS.gov.

https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Whats-New/Whats-New.html

Additional Changes to the MSPRP

Additional changes to the MSPRP were also noted in the View/Request Authorizations Section. The difference between a Consent to Release, Proof of Representation and Recovery Agent Authorization are clearly explained. Additionally, the MSPRP now outlines exactly what actions can be performed with each type of authorization for BCRC and CRC cases.

Consent to Release Authorization – With a verified Beneficiary Consent to Release authorization, an individual/entity can view and request authorization and view claims listings for BCRC and CRC cases. Additionally, on CRC cases, an individual/entity can view case data once a Conditional Payment Notice (CPN) has been issued.

Proof of Representation Authorization – With a verified Proof of Representation authorization, an individual/entity can view and request authorizations and view claims listings for BCRC and CRC cases. Additionally, on BCRC cases, the individual/entity may dispute unrelated claims and provide the notice of settlement information (beneficiary-debtor cases only). For CRC cases, the individual/entity may view case data once a Conditional Payment Notice (CPN) has been issued.

Recovery Agent Authorization – An individual with a verified Records Agent Authorization can view/request authorizations, view case data and view/dispute unrelated claims on all BCRC cases and on all CRC cases once a Conditional Payment Notice (CPN) has been issued and if no claims dispute has been made on the case.

Actions Available to All Users – All users, even without the authorizations noted above, can request a copy of the conditional payment letter (which will be sent to the beneficiary and authorized parties) and can request an updated conditional payment amount.

We will continue to monitor the MSPRP for any additional changes.