Conditional Payments In Settlements With Medicare Beneficiaries
Before settling a case with a Medicare beneficiary, the parties need to determine whether Medicare has a reimbursement interest in medical payments it has made to the Medicare beneficiary that it believes are another entity's responsibility. These are known as conditional payments. It is important to determine conditional payment interests, and resolve them, as part of the settlement in order to avoid having to make an additional payment after the settlement is finalized.
In October 2015, the Centers for Medicare and Medicaid Services (CMS) outsourced to the Commercial Repayment Center (CRC) the responsibility for recovery of CMS' conditional payment interests where CMS is pursing recovery directly from insurers (liability, self-insured, no-fault or worker's compensation) with ongoing responsibility for medical care.
According to CMS, the CRC has issued more than 33,000 Conditional Payment Letters and Conditional Payment Notices since the transition. Many, however, are still awaiting these demand letters. CMS published a bulletin on February 9, 2016 addressing issues encountered in implementing conditional payment recovery actions against insurers.
As the CRC refines its operational processes, we should expect to see an increased volume of recovery actions against insurers.
For more information, contact Ann Stewart
This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader should consult with legal counsel to determine how laws or decisions discussed herein apply to the reader’s specific circumstances.