Medicare’s Final Conditional Payment Process - Changes Ease Settlement

Posted by Brian Cox on Jan 12, 2016 9:43:00 AM

Find me on:

As of January 1, 2016, Medicare is offering a new process known as the “Final CP” process. In short, this new provision allows for authorized MSPRP users to notify Medicare that they will be settling a Medicare beneficiary’s liability claim within 120 days and to request a Final Conditional Payment Letter (CPL) with a specified lien amount BEFORE settlement.

This can be a huge relief for claims adjusters and claims managers who have so often been stuck in a Catch-22 when dealing with Medicare liens: they haven’t been able to receive a Final Demand Letter (FDL) until they settle, but at the same time, without a FDL in hand, they can’t arrive at an appropriate settlement amount without relying on an educated guess.

Medicare’s Final Conditional Payment Process is a plus for insurance companies looking to make smart, educated decisions on fair settlement amounts when working with Medicare beneficiaries.

unspecified.jpg

The nitty-gritty on the new Final CP process:

This new program allows authorized MSPRP users to notify CMS that settlement will take place in 120 days or less. As an authorized MSPRP user and Medicare Compliance Company, Flagship Services Group can help you take advantage of this new process. The authorized user notifies Medicare and asks that the claim be included in the Final CP Process.

Once the claim is within 3 days of settling, Flagship can request a Final Conditional Payment Amount on the MSPRP. Once calculated, the amount will remain the Final Conditional Payment Amount IF:

  • The case is settled within 3 calendar days of REQUESTING the Final Conditional Payment Amount and
  • Settlement information is submitted through the MSPRP within 30 calendar days.

What does this mean?

Claims adjusters can ask Flagship to use this process if all of the following are true –

  • The claim is a liability claim.
  • The claim is going to be settled in 120 days or less.
  • The client has previously referred this claim to Flagship.
  • Flagship has a signed Proof of Representation form from the claimant and it is on file with Medicare.

The new Final CP process takes the guesswork away, mitigates risk, and protects your financial resouces. Unlike Medicare’s current process, this new provision allows you to “preview” the final medicare lien amount BEFORE settling. We know it’s a lot to take in, but it’s all good news! Contact us to discuss the details any time and to see how we can help you take advantage of this new provision from Medicare.

New Call-to-action

Topics: Compliance