The Medicare Secondary Payer Recovery Portal (MSPRP) is a tool developed by CMS several years ago to allow for online access to their recovery processes. On Thursday August 16th, CMS hosted a Medicare Secondary Payer Recovery Portal (MSPRP) Overview Webinar to discuss some recent enhancements to the system.
To reduce the number of calls that they receive regarding the status of their cases, one of the improvements made is the new “Letter Activity” tab. This tab allows insurers and their authorized representatives the ability to view the status of their incoming and outgoing correspondence on cases.
Another new feature allows both the insurers and beneficiaries (and their representatives) the ability to now request electronic letters including Electronic Conditional Payment Letters (e-CPL).
NuQuest looks forward to utilizing these enhancements to assist our clients in what we are hopeful will be a more efficient conditional payment recovery process and will continue to monitor the efficiency and accuracy of these recent changes.
NuQuest strives to save our clients’ money, even years after the original settlement. One example is how a claim that was recently amended saved our client $567,706. Although the original CMS approval in January 2015 was for $780,736, a CMS Amended Review was requested by our client, due to a change in the treatment plan. Our updated review reduced the claim amount to $213,030, and the amended proposal was approved by CMS.
Our clients choose NuQuest as their trusted Medicare and MSP Compliance partner because we have a reputation for honesty and dependability. Over the years, we have assembled a core of specialists with industry-leading expertise in the areas of medicine, law and benefits. Contact us today to discover the NuQuest difference.
On 8/16/2018 at 1:00 PM EDT, the Centers for Medicare and Medicaid Services (CMS) will be presenting an “Overview Webinar” on its Medicare Secondary Payer Recovery Portal (MSPRP). The MSPRP is a useful tool in assisting parties regarding the Benefits Coordination and Recovery Center (BCRC) and Commercial Repayment Center (CRC)’s collection of conditional payments. Click here to be directed to the notice.
Once BCRC has been notified of the settlement, judgment or award (TPOC), BCRC will generally issue Medicare’s final lien with respect to the claim’s settlement.
This process above should not be confused with the Commercial Repayment Center’s (CRC) separate collection for Ongoing Responsibility of Medical (ORM) reporting. CRC’s notice and initial determination process is not a final lien from Medicare. If ORM has been reported or terminated, CRC may issue a separate collection against the carrier or self-insured based upon the ORM reporting. In certain circumstances both companies CRC and BCRC may initiate collection over the life of the claim.
It is important to remember that, at this time, the MSPRP only provides information with respect to payments made under Medicare Part A and Part B. There is yet to be a mechanism requiring CMS to advise its Part C and Part D partners that it has been notified of a TPOC or ORM reporting, legislators are trying to impact this issue through the Provide Accurate Information Directly Act, “PAID Act”, H.R. 5881.
A follow up will be posted after the 8/16/18 presentation.
At NuQuest, we strive to remain a strong leader in the MSA industry. One way we do so is to closely monitor the CMS approval process and to bring to their attention any improper judgments. The case study below is an example of how NuQuest takes the time to bring errors to light, not only for our clients but for the entire industry.
The claimant sustained a right shoulder injury on Oct. 1, 2016, and underwent an arthroscopic rotator cuff repair on Apr. 27, 2017. On Aug. 11, 2017, the treating orthopedist noted that she was doing well and that she requested additional physical therapy. Her medications at the time included Tramadol 50mg every eight hours, as needed. As a result of the follow-up visit, additional physical therapy was prescribed, and she was advised to follow up, as needed. No additional medications were prescribed.
A Panel Qualified Medical Evaluation (PQME) was completed on Dec. 17, 2017, and it noted that the claimant had not returned to the treating orthopedist. She was placed at maximum medical improvement with a 4% impairment rating. The PQME noted she was not a candidate for additional future medical treatment and should continue with a home exercise program.
In the absence of a pharmacy ledger, our MSA included Tramadol 50mg #90 per month for her life expectancy. As there was no indication of ongoing physician visits; we allocated two physician visits per year for her life expectancy as Tramadol is a Schedule IV drug. Prescriptions for Schedule IV controlled substances may be refilled up to five times in six months. Therefore, a new prescription is required every six months, which would need two physician visits per year. CMS increased the physician visits to four times per year with the only explanation being additional physician visits “are necessary.”
NuQuest requested a re-review based on a potential CMS error. Our re-review request advised CMS that physician visits are required twice a year when Tramadol is being prescribed, as it is a Schedule IV drug. Tramadol is not a Schedule II drug, the increase to four physician visits a year was an error by CMS. CMS completed the re-review and reduced the physician visits to two per year.
While the decreased MSA amount was not significant, NuQuest knows that it is important to advise CMS when an error is made. Otherwise, CMS would continue to increase physician visits to four per year when Tramadol is being utilized and no active treatment is being provided.
Conditional payment collections can occur under various circumstances in non-group health plan claims and can leave parties bewildered regarding how and when an appeal can be filed. The audience will be provided with outline of appeal process and time frames, effective defenses and case studies of successful conditional payment negotiations with Medicare.
Register here to join us on Wednesday, August 1st at 3:00 PM (EST) with Patrick Czuprynski, Director of Lien Resolution.