By Jason D. Lazarus, J.D., LL.M., MSCC, CSSC
The MSPRC halted issuing Rights and Responsibilities (“RAR”) letters along with Demand letters on 5/25 in response to the Haro Decision which enjoined Medicare from certain MSP collection practices. On 6/10 the MSPRC resumed issuing RAR letters in modified form. The new letters contain one very important change (with a few other non-noteworthy minor changes). The following paragraph was amended with the italicized language being added:
“Once you receive a settlement, judgment, award or other payment for your insurance or workers’ compensation claim, Medicare will determine if it has a recovery claim which must be repaid to the Medicare program. If Medicare determines that it has a recovery claim, you will be provided with a demand letter, which will include applicable appeal and waiver or recovery rights. Medicare will not take any collection action during the pendency of any appeal or waiver request. (The applicable law can be found at 42 U.S.C. 1395y(b)(2)(A) & (B). )”
The italicized language seems to be a direct result of the holding in Haro which prohibits Medicare from recovery actions during the pendency of appeal or waiver requests of conditional payments. Before revision of the RAR letter, that sentence was simply absent. Unfortunately, demand letters are still not forthcoming and it baffles me why not. Making some simple changes such as the one made to the RAR letters is all that is really necessary.
The letter also references Conditional Payment Notices (CPN). A CPN is issued when settlement is reached but a Conditional Payment Letter hasn’t been issued. This can be the result of failure to report the settlement to the COBC which is what initiates the process with the MSPRC. The process is as follows:
Conditional Payment Resolution Process
Contact Coordination Of Benefits Contractor (“COBC”) to report via telephone:
- Report: Name, HICN, Gender, DOB, Address and Phone Number, Date of injury/accident, description of injury, type of claim, insurer/wc carrier info, attorney name, law firm name along with address as well as phone number
COBC Call Center: 1-800-999-1118
Hours of Operation: Monday –Friday 8am-8pm (EST)
1. Within one week, send copy of retainer or proof of rep to MSPRC in OK (cover sheet on MSPRC site) (if not done, atty will not get copies of correspondence)
2. Once case is established through COBC, you get Rights and Responsibilities (“RAR”) Letter from MSPRC
3. Within 65 days of the RAR letter, a Conditional Payment Letter (“CPL”) is generated
4. Upon receipt of CPL, challenge for unrelated care
5. Once settlement is reached, submit to MSPRC:
- Settlement Amount
- Attorney’s Fees and Cost
6. MSPRC issues demand letter
Appeal, Request Waiver or Pay. If not paid, interest accrues and referred to Treasury for recovery action (42 U.S.C. §1395y (b)(2)(B)(i)(ii)(iii))
Tip: If appealing, pay the amount to stop the accumulation of interest.
To avoid delays, make sure you report to the COBC to start the process. This will trigger issuance of the CPL letter and avoids the delay of getting a CPN instead which drags out the timeline for resolution of the conditional payment. If you do get a CPN, you can call the MSPRC and request a final demand now. While you may be asked about disputed charges when you request the final demand that can be handled via an appeal after you get the final demand if you desire to speed up the process.
To view the new CPL letter, click HERE