CMS Clarifies Rights of Payers to Appeal Conditional Payment Recoveries

The Centers for Medicare and Medicaid Services have outlined some caveats in the newly-created appeals process payers can engage in for conditional payments. Conditional payments are those medical expenses that Medicare has paid for, but for which a third-party payer, such as a workers' compensation insurer, is liable. When CMS discovers a conditional payment, it seeks to recover the money from the liable payer. Up until April 28, payers had no way to appeal that, but now a four-step process has been enacted through which they can contest their liabilities. However, CMS spokespeople clar...