By Shawn Johnson
The Centers for Medicare and Medicaid Services (CMS) has released an updated Medicare Secondary Payer Recovery Portal (MSPRP) User Guide Version 5.0 (October 5, 2020). This new guide replaces Version 4.9 (July 13, 2020). As part of the Version 5.0 updates, CMS has made several updates to the MSPRP, which the agency lists in Chapter I (Summary of Version 5.0 Updates). Overall, the new changes aim at updating the claims listing interface to provide additional functionality.
Claims Listing Enhancements
As part of this update, authorized and authenticated users logged into the MSPRP using multi-factor authentication (MFA) can now view additional information on the “View/Dispute Claims Listing” page of the MSPRP. Specifically, when viewing the claims listing, an authorized and an authenticated user can sort and filter the listing of charges Medicare is seeking reimbursement for using several columns. Users can sort and filter by claim control ID, provider name, date of service, total charged amount, dispute submitted date or dispute decision date.
Further, there’s now functionality that allows authorized and authenticated users to export the listing of charges to an Excel spreadsheet. This spreadsheet, per CMS, should contain the full listing of charges for which Medicare is seeking reimbursement, including the provider name, dates of service, ICD codes, relevant DRG/CPT/HCPCS codes, charged amount, Medicare reimbursement amount, and conditional payment amounts.
Overall, these changes add increased functionality to the MSPRP, which may help users analyze and respond to Medicare conditional payment correspondence.
“Unverified” Authorization Status
The new MSPRP User Guide also indicates that an “Unverified” status has been added for Proof of Representation (POR) or Consent to Release (CTR) authorizations uploaded to the MSPRP. The MSPRP User Guide has been updated to indicate that when a POR or CTR is submitted via the MSPRP, Medicare will attempt to verify the authorization’s information. If the authorization is under review, it may now show as “Unverified.” If an authorization is not verified, users may be limited in accessing or viewing some information or functionalities on the MSPRP. Given this, it may be important to track submitted authorizations and follow up with the appropriate Medicare contractor to ensure authorization is verified correctly.
Please do not hesitate to contact the author if you have any questions or would like further information on how ISO Claims Partners can help you address your conditional payment claims. We offer several cost-effective and proven compliance solutions to help you stay compliant and reduce your conditional payment exposure, including our programmatic CP Link. In 2019, we saved our clients $59 million in conditional payment disputes and reduced 65% of conditional payment dispute submissions to zero dollars. So far in 2020, we have saved our clients over $38 million in conditional payment disputes.