Tag Archive for: MSPRC


CMS to Combine MSPRC and COBC; Appoints Interim MSPRC Contractor

The Centers for Medicare and Medicaid Services (CMS) will combine its Medicare Secondary Payer Recovery Contractor (MSPRC) and Coordination of Benefits Contractor (COBC) contracts into a centralized contract, called the “Medicare Secondary Payer Integration Contractor (MSPIC)”. CMS hopes that by merging these activities, they can provide a single point of contact, improve data and debt collection, and enhance customer service.

The current MSPRC contract, awarded in 2006 to Chickasaw Nation Industries, Inc. a tribally owned, Oklahoma based firm, expires on September 30, 2011 and will not be renewed.

Beginning October 1, 2011, the MSPRC work will be performed by Group Health Incorporated (GHI) until the new MSPIC contract is awarded.  Group Health Incorporated has been CMS’ COBC contractor since 1999.

The new MSPIC contract “sources sought notice” was posted on the website August 24, 2011. CMS anticipates that the MSPIC contract will be awarded in late spring/early summer of 2012.

Chickasaw Nation Industries’ performance came under fire recently by the U.S. Senate Subcommittee on Contracting Oversight, sighting “ongoing performance problems”, “significant deficiencies” and “failure to respond to communications in a timely manner”.  The MARC Coalition, formed in 2008, has been a strong advocate to reform the Medicare Secondary Payer recovery process and was the driving force behind the introduction of the SMART Act of 2011 by the U.S. Congress.  Also, recent congressional hearings by the Oversight and Investigations Subcommittee pointed out serious problems with the entire recovery process.  CMS seems to be responding to these complaints with strong positive changes.  In 2011, CMS awarded a new WCRC contract to Provider Resources, Inc., implemented a $300 threshold for liability settlements, and now it has made a major change in its MSPRC contract.

View the Sources Sought Notice at here.
View the Senate Subcommittee on Contracting Oversight fact sheet here.
View the MARC Coalition website here.
View the Medivest blog on the SMART Act of 2011 here.
View the Medivest blog on the US Congressional Oversight and Investigations Subcommittee hearings here.


MSPRC Resumes Issuance of Rights & Responsibilities Letter

On June 10, 2011, the Medicare Secondary Payor Recovery Contractor (MSPRC) resumed the process of issuing their Rights & Responsibilities (R&R) Letters.

On the heels of a recent court decision in Arizona (see Haro v. Sebelius), the MSPRC announced a temporary suspension of R&R letters and Demand letters.  This led many to speculate that the Haro decision played a role in the review the MSPRC was conducting on the letters.  In the Haro Case, the US District Court of Arizona held, in part, that CMS couldn’t collect disputed amounts from beneficiaries or attorneys.

The new R&R letter certainly appears to supports that opinion. The new wording in the letter specifically states “Medicare will not take any collection action during the pendency of any appeal or waiver request.”  There are several additional changes to the letter, however the suspension of the collection efforts during an appeal is the most noteworthy.

To read the updated Rights and Responsibilities Letter, please click here.

MSPRC Announces R&R Review Complete; Suspension Continues.

On May 26, 2011, we informed you that the MSPRC announced a temporary suspension from issuing both the Rights and Responsibilities (R&R) and the Demand Letters because both of those letters were under review.

Today, the MSPRC announced, on their website, that:

  • Demand Letters – There is no change.  The demand letters are still being reviewed by the MSPRC and are still suspended until the review is completed.
  • R&R Letters – The review is complete, but the suspension will continue until the revised letters are made available on 6/10/11.

It is important to understand that nothing really changed with this announcement except that the MSPRC completed the R&R Letter review and expects R&R Letters to resume on June 10, 2011.

Stay tuned.

The official MSPRC 5/31/2011 announcement reads as follows:

ALERT UPDATE: Issuance of the Demand letters is temporarily suspended – Review of the Rights and Responsibilities letter is complete
The Demand letter for liability insurance (including self-insurance), no-fault insurance and workers’ compensation has been temporarily suspended while this letter is under review. The MSPRC is still working cases, and Demand letters will be mailed out once this review is complete. Review of the Rights and Responsibilities letter (“RAR”) is complete. Issuance of the RAR is anticipated to resume on June 10, 2011. A copy of the revised RAR will be made available by that time on this website.

MSPRC Announces Temporary Suspension of Rights and Responsibilities and Demand Letters

A few days ago the Medicare Secondary Payer Recovery Contractor (MSPRC) posted the following ALERT on its website:

News and Updates Alert: Issuance of the Rights and Responsibilities (RAR) and Demand letters has been temporarily suspended
Issuance of the Rights and Responsibilities (“RAR”) and Demand letters has been temporarily suspended while these letters are under review. The MSPRC is still working cases, and the RAR and Demand letters will be mailed out once appropriate revisions have been made.”

The MSPRC is a Medicare contractor with the responsibility of protecting the Medicare trust fund by identifying and recovering payments Medicare made when another entity had primary payment responsibility. The current contract is held by Chickasaw Nation Industries, Inc.

The RAR letter is the letter the MSPRC sends to the claimant, with a copy to the claimant’s counsel, when they learn that the claimant has made a claim against a workers’ compensation or other insurance plan. The letter explains the obligation to reimburse Medicare for conditional payments, asks for legal representation information, asks for information about the claim and the insurance carrier, asks that settlement information be forwarded if a settlement occurs, and explains that a conditional payment letter will be sent within 60 days showing conditional payments Medicare has made on the claimants behalf.

Demand letters are sent to claimants and insurers to formally advise the debtor of the amount of money due the Medicare program. They state the amount owned and that the debtor has 60 days to respond or the matter might be turned over to the US Department of Justice for legal action and/or the Department of Treasury for other collection action.

There is no official word as to why the MSPRC is reviewing these letters. But it seems likely that it is because of the court decision recently reached in Haro v. Sebelius (see May 16, 2011) where the U.S. District Court of Arizona ruled, in part, that CMS cannot collect disputed amounts from beneficiaries or attorneys.

The impact of this suspension will depend on how long it lasts. We have been experiencing a slowdown in MSPRC response times lately so our hope is that this additional delay is short-lived.
Medivest will provide updates as soon as we receive information that this temporary suspension is lifted.

To view the MSPRC Alert click here
To view the May 16, 2011 Haro v. Sebelius blog click here


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 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 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.