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CMS Portals Open the Door to Compliance

A look at the development and implementation of CMS’ Medicare Secondary Payer Recovery Portal.

June 14, 2013 Photo

As we transition into summer, I have a sunny topic to discuss with you: the development and implementation of CMS’ Medicare Secondary Payer Recovery Portal (MSPRP). 

On July 2, 2012, CMS rolled out the MSPRP, a Web portal that allows qualified users to gain access to conditional payment information, dispute conditional payment charges, and request CMS’ final conditional payment demand online. The portal is available to Medicare beneficiaries, insurers, third-party administrators, attorneys, and designated representatives. To qualify, all prospective users—with the exception of Medicare beneficiaries—must first complete CMS’ electronic registration process.

Benefits Received

While there are still certain limitations to the use of the MSPRP (for instance, a user must request and receive ICD-9 codes, dates of service, and providers via regular mail), qualified users of the portal have benefited. For example, parties must obtain releases from the MSPRP. These documents, known as proof of representation and consent to release, took up to 21 days for verification by CMS before the implementation of the Web portal. Now, CMS can verify these releases in less than a week. That allows the parties to proceed with investigation of conditional payments in a much more expeditious manner.

The MSPRP also has helped parties to a potential settlement get a quick snapshot of their conditional payment exposures. Pre-portal timeframes for CMS to process requests for updated conditional payment amounts could exceed 45 days. A qualified user now can gain access to this information from the portal in one to three days.

The obvious benefit here is that parties can identify quickly whether the amount of a lien will be a serious impediment to settlement. However, the caveat is that the portal only provides the amount of the conditional payment. For complete visibility, the parties must still request ICD-9 codes, dates of service, and provider information through the mail.

If the conditional payment amount reflected in the portal search raises any eyebrows, either by being too high or too low, the parties know early on in the settlement process that further investigation is necessary to redress this issue.

Using the MSPRP also makes actual negotiation of conditional payments easier. Users can expect to receive an updated conditional payment letter in three weeks versus 45-plus days. Negotiation with CMS may then begin through the portal. In the past, negotiations with CMS could take anywhere from 45 to 65 days (or much longer, according to reports I have received from CLM members and fellows from the field). By using the portal, many report that it is possible to conclude conditional payment negotiations in half the time.

All Things Final

Once the parties have settled their claim, a party must request the final demand from CMS. To do this, they must submit information about the settlement to CMS, which includes the settlement amount, date of the case settlement, and attorney fees.

Prior to the implementation of the MSPRP, CMS’ issuance of its final demand could take 45 to 65 days from the date of submission of the settlement detail. The MSPRP allows the parties to upload settlement information online, which results in a faster turnaround time. CMS’ faster production of the final demand allows for faster reimbursement by the parties of CMS’ conditional payments and timely claims closures.

While CMS has made no formal or informal pronouncements as to future improvements to the MSPRP, CMS has made some enhancements recently with respect to data processing and filtering functionality. It is reasonable to assume the MSPRP will change because of the enactment last January of the Strengthening Medicare and Repaying Taxpayers (SMART) Act, with its specific provisions modifying the conditional payment recovery process. Since the SMART Act is still in its regulatory phase, more likely than not, I will be giving you an update when the leaves are falling later this year.

Note that no regulations or CMS memos, alerts, or other writing or statements codify such time frames. The timeframes reflected in this article derive from our daily course and practice in using the MSPRP. Obviously, timeframes may be longer depending on the facts and complexity of the individual claim and may differ widely depending on the submitter, information submitted, and other extenuating circumstances. 

In my next column, I will update you on the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP). Like the MSPRP and settlement of conditional payments, the WCMSAP has helped streamline the submission and review process for Medicare Set Asides in workers’ compensation cases. I look forward to sharing some insights about this portal and other changes to the submission process of Medicare Set Asides.

As always, please feel free to email me at jsmythe@cpscmsa.com with your comments and questions.   

About The Authors
Jessica Smythe

Jessica Smythe is assistant vice president of customer relationship management at ISO Claims Partners, a member of the Verisk Insurance Solutions Group at Verisk Analytics. She has been a CLM Fellow since 2011 and can be reached at jsmythe@iso.com.  

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