As previously reported weeks ago, ongoing changes are being considered with regard to Medicare. The Centers for Medicare & Medicaid Services (CMS) has indicated they will be implementing an option for certain Medicare beneficiaries to obtain Medicare's final conditional payment amount prior to settlement.
This option is noted to likely be available in February 2012 but only for certain settlements where treatment has been completed. Under this option, the beneficiary or his representative will calculate the amount of Medicare's conditional payment amount using information received from the Medicare Secondary Payer Recovery Contractor (MSPRC), the MyMedicare website, or other claims information available to the beneficiary and ask MSPRC to review this amount. If they find the amount accurate, they will respond with Medicare's final conditional payment amount within 60 days—settlement must then occur within 60 days of the date of Medicare's response.
The following criteria must be met to utilize the option:
· Settlement will be for a physical trauma based injury (not ingestion, exposure, or medical implant);
· Total liability settlement, judgment, award, or other payment would be $25,000 or less;
· Incident occurred at least six months before the beneficiary or his representative submits proposed conditional payment amount to Medicare;
· Beneficiary demonstrates treatment has been completed and no further treatment is anticipated with some written physician attestation or by certifying in writing that no medical treatment related to the case has occurred for at least 90 days prior to submitting the proposed conditional payment amount to Medicare.
Detailed instructions on how to use this process will be posted at www.msprc.info by January 15, 2012. It appears the option may be expanded as CMS gains experience with the process.
We will continue to report as updates are provided from CMS or through a number of additional sources and resources. Please feel free to contact Shawn R. Biery, J.D., M.S.S.C. at firstname.lastname@example.org with any questions regarding Medicare Set-Aside issues. Feel free to post them on our blog at: http://keefe-law.com/kcablog.html