The MSPRC’s New Use of Conditional Payment Notices

Medicare’s MSPRC began sending Conditional Payment Notices (“CPNs”) last year.  At that time, MSPRC representatives explained the use CPN in Town Hall Meetings.  That use has seemingly changed.

What is a CPN?  It is notice given by the MSPRC that:

  1. It is aware you have settled;
  2. It may not know the settlement amount, fees, and costs taken;
  3. If you fail to respond, the Medicare lien cannot be reduced based on settlement amount, fees, and costs; and,
  4. The conditional payments (Medicare lien) amount to X, you may dispute those charges prior to a final demand and avoid the appeals process.

The original purpose of a CPN was strictly where the MSPRC learned of a settlement without the plaintiff notifying it.  That made sense with the MMSEA going into effect – even if the Medicare mandatory reporting moratoriums continue.  More and more settlements will be reported by defendants before plaintiffs once the MMSEA takes effect.

Now, we see CPNs being issued where no Conditional Payment Letter had been issued.  If you notify the MSPRC of settlement, but have not received a Conditional Payment Letter (initial Medicare lien), you will get a CPN.  The problem with this is that it slows you further.  By issuing CPNs, the MSPRC is taking another 45 days on top of the “35 days” you should have waited for a Final Demand and instead received a CPN.

This is especially frustrating to those of us who realized we could skip the Conditional Payment Letter stage if we wanted Final Demands faster.  Moreover, the language of the CPN often causes concern: Did the MSPRC receive the settlement information from me?  Are my fees and costs included?  Usually the answer to those questions is yes.  It sent a CPN instead of a Final Demand because there had not been a Conditional Payment Letter.  In theory – this is a nice gesture by them.  You can see a Medicare lien before it becomes a Final Demand.  You can dispute charges in the 45 day interim period.  But it adds another 45 days (at least).

So how can you avoid the Conditional Payment Notice stage?  As always: Start early!  If you notify the COBC of your case early in the litigation process you will get Conditional Payment Letters.  Then, when you settle, you will get a Final Demand, rather than a CPN.

If you forget to start the Medicare lien resolution process early enough, or simply settle quickly (good for you!), you can still reduce the CPN time frame.  When you receive the CPN you should call the MSPRC and tell them you want a Final Demand now.  The representative may ask if you disagree with any charges – but that is not relevant.  You can still appeal after the Final Demand.  This phone call may cut as much as a month from the CPN/Final Demand interim period (if you can bear waiting 2 hours on hold).

Remember, start early on Medicare liens.  Notify the COBC as soon as possible.  If you need assistance with Medicare liens, Medicaid liens, ERISA liens, or any other healthcare liens, contact LRS.

Ryan J. Weiner
Co-Founder Lien Resolution Services
This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

2 comments on “The MSPRC’s New Use of Conditional Payment Notices

  1. […] Finally, language has been added explaining when a Conditional Payment Notice will be issued.  As discussed in the past, the CPN is used where a Final Demand has been requested, but the 65 day time period has not passed for a Conditional Payment Letter.  Please click for more on the CPN process. […]

  2. […] I saw more Conditional Payment Notices from Medicare in one day, than I had the entire month of April.  Conditional Payment Notices […]

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