January 15, 2020 –
NuQuest recently obtained a favorable response from a BCRC demand (Medicare’s collection based upon settlement). Medicare removed $119,000.00 in charges.
It is Medicare’s burden to demonstrate their payments require reimbursement. NuQuest reviews each date of service listed in Medicare’s payment summary form and makes a determination if a date of service is disputable based upon current legislation, case law, Medicare trends and regulations.
This is in part because not every date of service is clearly associated/not associated with a particular claim and there may be circumstances where a date of service or treatment could be for an accepted condition on the claim, but not payable under the particular state law or provisions under the Medicare Secondary Payer Act and regulations.
Looking beyond the related/unrelated argument was paramount in reducing Medicare’s lien in this circumstance and charges that appeared related to the settlement were removed, not requiring reimbursement.
This strategy has saved our customers over 10 million this year alone in conditional payment reimbursements and over 40 million in the past three years. Please contact us with any questions.
All that glitters is not gold: Medicare’s Open Debt Report
In recent months, Medicare provided a “open debt report” option on the Medicare Secondary Payer Recovery Portal (MSPRP). This option is available to account managers who have registered onto the MSPRP. However, an account manager is only able to obtain an open debt report associated with the Tax ID specifically used to register the account on the MSPRP.
This means a TPA or vendor is not able to obtain an open debt report for their customers (Carrier/Self-insured), unless the carrier/self-insured registers on the portal itself and distributes the report.
This issue has been brought to the attention of Medicare, but no update has been provided. As this issue develops, we will provide additional information. Please contact us with any questions.