Final Rule Regarding Expansion of the Functionality of the Medicare Secondary Payer Recovery Portal

CMS, Conditional Payments, MSP News on May 19, 2016
Posted by Erin O'Neill, PA-C, JD

On May 17, 2016, The Centers for Medicare and Medicaid Services (CMS) released the final rule, specifying the timeline and process for expansion of the current Medicare Secondary Payer Recovery Portal. The Final Rule, entitled Medicare Program; Obtaining Final Medicare Secondary Conditional Payment Amounts via Web Portal was published in the Federal Register and can be viewed at the following link:

In September 2013, the interim final rule was published in the Federal Register (78 FR 57800). Twenty-one public comments were received and a general overview of these comments is included in the final rule released by CMS. A few of the comments addressed the following issues:

  1. Clarification regarding what it means to dispute a claim once and only once.
  2. Clarification regarding what it means to provide initial notice and why notice about the impending settlement must be supplied separately.
  3. Confirmation of whether Medicare continues to make conditional payments up through and including the date of settlement.
  4. Continued inclusion of the limitation that an anticipated settlement can only be reported once.
  5. Continuation of the 3 day settlement timeframe as established by the SMART Act.
  6. Retention of the language referencing future medical items and services.

The final rule specifies the timeline for development of a Multifactor Authentication (MFA) as well as the inclusion of functionality on the MSPRP to allow users to notify CMS that a settlement is pending; obtain final conditional payment summary statements; and ensure that 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 functionality to obtain a final conditional payment amount on those cases that are 120 days or less from an anticipated settlement began on January 1, 2016.

Of note, 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.  The timeline diagram, included with the rule, indicates that a dispute can only be submitted once on each conditional payment; however, relatedness can be disputed on any additional conditional payments that have not already been disputed.

These regulations will be effective June 16, 2016.