Synergy Blog

SMART Interim Final Rule and File Handling Flow Chart

By Dave Place, J.D., Director of Lien Resolution

On September 20, 2013 The Centers for Medicare & Medicaid Services (CMS) issued an Interim Final Rule laying out the expanded functionality of the Medicare Secondary Payer Web Portal.  Currently the MSP Web portal permits authorized users to register through the Web portal in order to access MSP conditional payment amounts electronically and update certain case-specific information online.

CMS is adding functionality to the existing MSP Web portal that will permit users to notify them when the specified case is approaching settlement and download time-date stamped Final Conditional Payment Summary forms as well as amounts before reaching settlement.  Additionally, the new MSP Web portal will ensure that relatedness disputes and any other discrepancies are addressed within eleven (11) business days of receipt of dispute documentation.

Before the new MSP Web portal becomes available, a new user authentication protocol must be established.  The implementation of this new user authorization and verification process is scheduled for no later than January 1, 2016. Once this authorization process has been implemented, a beneficiary’s authorized attorney or other representatives (such as Synergy Lien Resolution Services “SLRS”) will have access to the beneficiary’s MSP conditional payment information for a specified MSP recovery case. This information will include dates of services, provider names, diagnosis codes and conditional payment amounts.

The process is rather straight forward and will address many of the issues that have plagued the plaintiff’s bar in attempting to settle a personal injury action without any certainty of the repayment amount due Medicare.  The process will begin when the beneficiary, their attorney or other representative (SLRS) provides the required notice of pending liability insurance settlement to the appropriate Medicare contractor at least one hundred eighty five (185) days before the anticipated date of settlement.

If the beneficiary, their attorney or other representative, believes that claims included in the most up-to-date Conditional Payment Summary form are unrelated to the pending liability insurance “settlement”, they may address discrepancies through a dispute process available through the MSP Web portal.  This dispute may be made once and only once.  Following the dispute CMS has only eleven (11) business days to resolve the dispute.

After disputes have been fully resolved, and a final claims refresh has been executed on the MSP Web portal, then a time and date stamped Final Conditional Payment Summary may be downloaded through the MSP Web portal. This form will constitute the Final Conditional Payment amount if settlement is reached within 3 days of the date on the Conditional Payment Summary.

The plaintiff attorney will complete the process by providing, within thirty (30) days settlement information to CMS via the MSP Web portal. This information will include, but is not limited to:

the date of “settlement”, the total “settlement” amount, the attorney fee amount or percentage, and additional costs borne by the beneficiary to obtain his or her “settlement”.  If this information is not provided within thirty (30) days the Final Conditional Payment amount obtained through the Web portal will expire.

This new functionality will be available no later than January 1, 2016

To view a diagram of the process, click HERE

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