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Goldstein: Efforts to Streamline Conditional Payment Recovery Process Continue

By Jean S. Goldstein

Wednesday, March 6, 2019 | 257 | 0 | min read

Last week, the Centers for Medicare & Medicaid Services announced two upcoming webinars aimed at addressing payment functionalities within both the Medicare Secondary Payment Recovery Portal (MSPRP) and Commercial Repayment Center Portal.

Jean S. Goldstein

Jean S. Goldstein

These latest enhancements to the conditional payment recovery process will enable users of the CMS-maintained portals to make electronic payments for identified conditional payments. The information for the MSPRP webinar can be found here.

Over the last year, we have seen several enhancements to the portal, as discussed here on our blog. As you may know, the Commercial Repayment Center’s contractor (CRC) is Performant, which took over the duty of enforcing conditional payment recoveries in February 2018. 

The conditional payment recovery process begins when a Medicare secondary payer “lead” is identified, which tips the CRC off to investigate whether Medicare has made conditional payments on a case for which there is a primary payer. These leads are identified by one of two manners: either through self-reporting (perhaps completed by a Medicare beneficiary or attorney) or through Section 111 reporting by a responsible reporting entity (RRE). 

If a case is self-reported, a conditional payment letter (CPL) is automatically generated. If a case is reported through Section 111 reporting, a conditional payment notice (CPN) will be issued. This distinction is important to note because a CPN has a required response time of 30 days in order to dispute any identified Medicare payments, while a CPL has an indefinite disputing period. 

These time frames may come into play in choosing when and how to make payment once the electronic payment feature is live on the portal.

To that extent, it is a good opportunity to address the current state of affairs with Performant and its conditional payment recovery efforts. As many are aware, upon assuming its new role Performant took over a backlog of cases from the previous contractor. These cases had not been addressed, and Performant attempted to work through the backlog.

During this transition period, CPLs were automatically generated on any self-reported cases. However, Performant has been issuing CPNs on cases more timely since October 2018. Performant has recently indicated that some older cases, which have been dormant for a number of years, but for which ongoing responsibility for medicals has not been terminated by an RRE, remain unaddressed.

However, Performant has further indicated that these cases will begin to be addressed and that we may begin to see recovery efforts launched by Performant. Most significantly, Performant has confirmed that overall conditional payment recoveries are ramping up once again, with approximately 150 new CPNs being issued each week on current claims.

It is important to note that the Department of Treasury has also once again restarted its collection efforts after many can attest to what was a brief hiatus.

Overall, we can expect to see continued enhancements to the MSPRP, which are certainly welcomed. However, alongside of these enhancements we will also experience a continued ramping up of conditional payment recovery efforts. 

Please be sure to check back after the March 13 webinar, as we will provide an update and summary.

Jean S. Goldstein is senior legal counsel for Medval. This post from the Medval blog is republished with permission.


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