CMS Announces New Conditional Payment Option Available in 2012

CMS has announced the implementation of another conditional payment option, available in February 2012. The “Self-Calculated Final Conditional Payment Amount” option is only available for liability insurance settlements involving a physical trauma based injury where the settlement is $25,000 or less and no further treatment is expected. The beneficiary or his representative will calculate the amount of Medicare’s conditional payment using information from the Medicare Secondary Payer Recovery Center (MSPRC), the MyMedicare website or other available claims information. The amount will be submitted to the MSPRC and if approved as accurate, the MSPRC will respond with the final coditional payment amount within 60 days. The beneficiary then has 60 days after Medicare’s response to settle in order to lock in the final amount.  Complete instructions will be posted on the MSPRC website by January 15, 2012. CMS notes that this is only an “initial step” to providing conditional payment amounts prior to settlement.  It will be intersting to see what develops from here.  For more information please visit www.msprc.info.