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MSPRC Announces Changes in Conditional Payment Procedures

The Medicare Secondary Payer Recovery Contractor (MSPRC) recently announced some significant changes in its procedures for handling Conditional Payments that became effective for cases established on or after October 1, 2009. Under the new process, obtaining conditional payment information begins, as before, with notifying Medicare’s Coordination of Benefits Contractor (COBC). But, after that, a series of new documents will be used which will help to streamline the entire process, as follows:

    1. Rights and Responsibilities Letter – This letter replaces the previous Right to Recovery Letter and is sent to the Beneficiary, the Beneficiary’s representative and the workers’ compensation/no-fault carrier (if the MSPRC has the correct contact information).

    2. Interim Conditional Payment – The MSPRC will issue interim conditional payment amounts automatically within 65 days from the date of the Rights and Responsibilities Letter to the Medicare beneficiary and any other authorized individuals. The fact that this is automatic (that is, it does not have to be requested) is a significant improvement and streamlines the whole process.

    3. Online Updates – Once the MSPRC has mailed out the Conditional Payment Letter, they will post the information on the MyMSP tab on the www.mymedicare.gov website. It will be updated weekly with any newly processed claims so the claimant, his attorney or other representative can keep track of medical bills that were paid by Medicare.

    4. Proof of Representation, Consent to Release, Carrier Letter of Authorization – There are three new documents authorizing others to review conditional payment information as follows:

    4A. Proof of Representation – This document is required to be submitted in order for the Medicare beneficiary’s representative to act on the beneficiaries behalf. CMS views this exchange of information as a “two way street” where the representative may interact with the MSPRC on behalf of the beneficiary, in order to resolve Medicare’s Recovery Claim.

    4B. Consent to Release – This document is submitted when the representative is only to receive certain information from the MSPRC for a limited period of time and is not authorized to act on the behalf of the beneficiary. CMS views this exchange of information as a “one way street” the representative can only receive information from the MSPRC but cannot act on the beneficiary’s behalf.

    4C. Carrier Letter of Authorization – In situations where a Workers’ Compensation or No-Fault Carrier retains a third party (such as Medivest) to deal with the MSPRC regarding conditional payment claims, a Carrier Letter of Authorization is required.

Interestingly, the MSPRC requires a Consent to Release document from a liability insurer, to provide conditional payment information but does not require it from a workers compensation carrier.These changes can be found, in much more detail, at the MSPRC website at http://www.msprc.info under eight different documents:

    • Alert – Rights and Responsibilities
    • Alert – Proof of Representation
    • Alert – Interim Conditional Payment
    • Rights and Responsibilities Letter
    • Rights and Responsibilities Brochure
    • Consent to Release – Model Language
    • Proof of Representation – Model Language
    • Proof of Representation vs. Consent to Release PowerPoint

This new process is a significant improvement that should expedite the resolution of the Medicare’s conditional payment recovery claims and therefore improve the entire settlement process.

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