2020 Recovery Threshold Amount Maintained at $750 for Workers’ Compensation, Liability, and No-Fault Medicare Beneficiary Settlements
Heather Sanderson
December 2, 2019

As required by Section 202 of the SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. Since 2017, CMS has maintained its threshold of $750.00 across all Non-Group Health Plan (NGHP) lines of business to include workers’ compensation, general liability, and no-fault insurance.  The threshold means that in scenarios where the Total Payment Obligation to Claimant (TPOC)/settlement amount is $750.00 or less, the claim does not need to be reported and CMS will not require reimbursement of conditional payments. Just last week, CMS announced that the threshold would remain at $750 for the calendar year 2020.  Therefore, no changes to reporting/conditional payment practices are required at this time. We will monitor for an update next November.