CMS Alert Announces Pre-Settlement Final Demand Functionality to Go Live January 1, 2016
Heather Sanderson
November 10, 2015

Yesterday, CMS issued an alert which states:

As part of the Strengthening Medicare and Repaying Taxpayers Act of 2012 (the SMART Act), the MSPRP will be modified to include Final CP process functionality by January 1, 2016.  This new functionality will permit authorized MSPRP users to notify CMS that a recovery case is 120 days (or less) from an anticipated settlement and request that the recovery case be a part of the Final CP process.

When the Final CP process is requested, any disputes submitted through the MSPRP will be resolved within 11 business days of receipt of the dispute.  Once all disputes have been resolved, and the case is within 3 days of settling, the beneficiary or their authorized representative will be able to request a Final Conditional Payment Amount on the MSPRP.  Once calculated, this amount will remain the Final Conditional Payment Amount as long as:

  1. The case is settled within 3 calendar days of requesting the Final Conditional Payment Amount, and
  2. Settlement information is submitted through the MSPRP within 30 calendar days of requesting the Final Conditional Payment Amount.

Please continue to visit this website for updated information.

Franco Signor Commentary: This is the last piece of the SMART Act to be implemented.  Technically it was supposed to be available 9 months after the SMART Act’s implementation (October 10, 2013). While this functionality took longer than anticipated, this is an exciting development. After January 1, 2016, settling parties will be able to obtain a Final Demand prior to settlement if CMS is notified 120 days or less that settlement is anticipated. This functionality will be extremely helpful for parties to be able to know the Final Demand prior to settling.  The SMART Act provides that CMS must be given at least 65 days’ notice prior to the settlement, judgment or award.

As for the dispute process, an 11-day resolution window by CMS is a quick turnaround time and should help to expedite settlement. However, if the CRC is handling the CP recovery, it is important to note that only disputes based upon relatedness can be submitted via the portal. All other disputes must be in writing. Therefore, if a dispute is being submitted based upon a legal argument, i.e., statute of limitations has lapsed, the dispute would have to be submitted outside of the portal, and it would seem that the 11-day turnaround time would not apply. CMS has not appeared to limit the type of disputes that can be submitted via the portal if the CP recovery is being handled by the BCRC.

While it may seem impractical for parties to settle within 3 days of requesting the Final Conditional Payment Amount, CMS has previously noted that the parties can simply re-download another time and date stamped Final Demand when ready to settle. There does not appear to be any limitation on the number of times that parties can download a Final Demand. We are eagerly awaiting this development in the MSPRP. Are you an authorized MSPRP user?  Allow us to be your MSP Compliance partner!  For questions, please contact us at engage@francosignor.com.

Heather Schwartz Sanderson, Esq., MSCC, CHPE, CLMP, CMSP
Chief Legal Officer
Franco Signor LLC