Medicare Secondary Payer Recovery Portal Released

The Centers for Medicare & Medicaid Services (“CMS”) have implemented a new online portal that assists parties in the resolution of Medicare (Parts A & B) Conditional Payment (“CP”) reimbursement obligations. Garretson Resolution Group (“GRG”) has been anticipating the portal’s release and we are looking forward to utilizing the tool in the resolution of Medicare reimbursement obligations, as it contains features designed to make the work of third-party resolution/compliance firms more efficient.

GRG has conducted an initial review of the portal’s functionality and the following is a brief summary we have prepared for our clients:

Medicare Secondary Payer Recovery Portal (“MSPRP”)

Functionality Available

• Add authorizations to established cases
• Request updated Conditional Payments (claims)
• Submit dispute of unrelated claims
• Submit settlement information and request Medicare’s Final Demand

Functionality Not Available

• Establish a new case. You must still contact Coordination of Benefits Contractor (COBC) to establish a new case
• Audit claims. The MSPRP does not provide full claims detail (ICD codes, provider names, etc.), limiting the user’s ability to review claims for unrelated charges. You must request that a hard copy CP be mailed in order to receive full claims details
• Request appeal, compromises and/or waivers. This is accomplished through traditional means outside of MSPRP
• Medicare Set-Asides. Resolution of future costs-of-care obligations cannot be accomplished within MSPRP

How will GRG incorporate the MSPRP into our current process and technology?

GRG is already working to bridge the MSPRC’s functionality with GRG’s currently available Compliance Connection web portal platform. GRG’s Compliance Connection is the industry’s first lien resolution web portal, offering our clients the ability to track the status of the lien resolution process. The next round of enhancements to Compliance Connection later this year will incorporate the information provided by the MSPRP and provide GRG clients with a 360-degree view of all case information for Medicare and other lien types and/or Medicare Set-Aside arrangements in one convenient tool.

How can and/or should GRG clients use the MSPRP?

Clients may find it beneficial to use the Medicare portal to request copies of Conditional Payments or updated pre-audit lien amounts.

GRG Client Advantages

GRG remains the preferred compliance partner for our clients who want to offload this complex and time consuming portion of personal injury claim resolution to an expert. As your overall compliance partner, GRG offers:

• Evaluation of cases to determine the best strategy for resolving all obligations;
• Experience in navigating the complex Medicare system for Parts A & B claims as well as Medicare Part C, ERISA/private healthcare, and military plan claims and for Medicare Set-Asides;
• Mandatory Insurer Reporting (MMSEA) coordination and guidance;
• Expertise in specialized areas such as mass torts, asbestos, and nursing home and/or medical malpractice;
• Auditing of claims for relatedness to maximize client recovery;
• Pursuing pre- and/or post- settlement compromises and/or waivers to maximize client recovery; and
• Global lien resolution services for mass tort and class action matters.

GRG will continue to explore the new Medicare portal and offer further guidance and insights about how it will be incorporated into the overall resolution process to improve the time to complete resolution and results for our clients. In the meantime, please do not hesitate to contact us with any questions or concerns.