Category Archives: Medicare Conditional Payments

Keeping Up with Conditional Payment Obligations

08 Jan 2020 Heather Sanderson No Comments

Blog, Medicare Conditional Payments

This article was originally published in the January 2020 issue of CLM Magazine. Keeping Up with Conditional Payment Obligations – Effective Strategies for Medicare Conditional Payment Recovery Cost Containment  Read the article from CLM Magazine or download the PDF.  

Top Medicare Secondary Payer Predictions for 2020

03 Jan 2020 Heather Sanderson No Comments

Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Conditional Payments, Medicare Secondary Payer News, Medicare Set Aside

Medicare Secondary Payer (MSP) developments will take center-stage in 2020 and drastically impact workers’ compensation, no-fault, and general liability insurance plans/carriers. With 2020 being an election year and healthcare matters as a primary issue for Americans, the continuing debate for Medicare for All, Medicare’s rising costs with an estimate of a spend of $651 billion dollars in 2019[1], two Notices …
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Blog, Medicare Conditional Payments, TPOC

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 …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Secondary Payer News, Pharma Part D

Insurance Companies and Self-Insureds that process claims for workers’ compensation, liability and no-fault claims (Primary Plans) involving Medicare beneficiary claimants need a better way to obtain information about Medicare Advantage and Part D Drug Plans that may have a claim for conditional payment reimbursement.  Numerous lawsuits have been filed across the Country demanding double damages for failure to reimburse Medicare …
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Blog, Medicare Advantage Part C

Recall last year in 2018 we blogged that Humana Medicare Advantage had filed an action against Bi-Lo, LLC, a grocery retailer, in the U.S. District Court for the District of South Carolina for declaratory relief and monetary damages to recover amounts allegedly due and owing to Humana Medicare Advantage Organization (MAO) for payments made on behalf of Enrollee (the Medicare …
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Blog, Medicare Conditional Payments

On August 9, 2019, the Commercial Repayment Center (CRC) held an industry conference call and announced it was under mandate to reduce the current backlog of 338,819 conditional payment leads.  Instead of inundating the industry with hundreds of thousands of Conditional Payment Notices (CPNs), the CRC plans to ask Responsible Reporting Entities (RREs) to update their Section 111 data.  By …
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Blog, Legal/Legislative News, Medicare Advantage Part C

The Wild Wild West of Medicare Advantage Organizations (MAOs) filing litigation nationwide against primary plans (workers’ compensation, liability or no-fault carriers/plans) to establish the right to a Medicare Secondary Payer (MSP) private cause of action for failure to reimburse the MAO for unreimbursed conditional payments continues. As of our last update, both the 3rd Circuit (encompassing New Jersey, Delaware and …
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Blog, Medicare Conditional Payments

As a continuing effort to update our readers on the Commercial Repayment Center (CRC), we are providing an update on the CRC’s recovery activities. Franco Signor has been notified that several large insurance carriers have received preliminary notice of a large number of potential debts that the CRC intends to issue Conditional Payment Notices (CPNs) or Demands on. Recall that …
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Blog, Legal/Legislative News, Medicare Conditional Payments, Medicare Secondary Payer News, Pharma Part D

Several of our clients have been experiencing an increase in conditional payment letters from Medicare Part D prescription drug plans. Historically, Part D plans have been less active in recovery of conditional payments than traditional Medicare or Medicare Advantage Part C plans; however, the tide appears to be changing. Why are Part D Plans recently increasing their recovery efforts? One …
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Blog, Legal/Legislative News, Medicare Advantage Part C, Medicare Jurisdiction, Trial Practice

Enforcement of the Medicare Secondary Payer (MSP) Act has been increasingly in the news lately, with results that are alarming for both primary plans and plaintiff attorneys. Primary plans beware: Earlier this week, in an decision entitled MSPA Claims v. Tenet out of the U.S. District Court for the Southern District of Florida, the Court dismissed Plaintiff MSPA Claims’ action …
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