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Medicare Conditional Payment Notices

Yesterday I saw more Conditional Payment Notices from Medicare in one day, than I had the entire month of April.  Conditional Payment Notices (“CPNs”) are different than Conditional Payment Letters (“CPLs”), but they should not concern you if you know how to respond.  This post will discuss what is a CPN, what do to with a CPN, and why I think we’re starting to see so many.

What is a Conditional Payment Notice?

Medicare’s Conditional Payment Notices is a sort of pre-Final Demand for the Medicare lien.  The MSPRC explains why it sent it in the very first sentence:

The Centers for Medicare & Medicaid Services (CMS) has been notified that you have received a settlement, judgment, award, or other payment related to your case for the Date of Incident listed above.

Simple, right?  The case has settled and it wasn’t you (or any plaintiff representative) who told Medicare.  The CPN does look nearly identical to a CPL, except that it shows three bolded statements that the CPL does not show:

  1. In all capital letters: “CONDITIONAL PAYMENT NOTICE” can be found near the upper-right corner of the letter.
  2. About one-third of the way down: “Current Conditional Payment Amount: $___.__.”  This subtly tells you that the MSPRC might still increase the Medicare lien.
  3. Just below the amount: “RESPONSE DUE BY: June 23, 2012.” Or always 30 days after the date on the letter.

How to Respond to the Conditional Payment Notice

So what next?  Send the MSPRC your settlement information, including:

  1. Date of Settlement;
  2. Settlement Amount;
  3. Attorney;s Fee; and,
  4. An Itemization of Case Expenses.

You should also send a dispute of payments if you find it necessary.  This will minimize the Final Demand and hopefully allow you to avoid the Appeals and Reimbursement Processes.  Regardless of what you do, the MSPRC will begin the process to generate a Final Demand the day after the listed response due date.  If you send a dispute the MSPRC will consider your arguments and potentially remove unrelated claims.  If you send your settlement information the MSPRC will apply the Statutory Procurement Formula to reduce the Final Demand by no less than 33 percent.  If you do nothing the MSPRC will send a Final Demand for the entire amount of Conditional Payments, plus any new claims it discovers to be related to the injuries (if it even knows the injuries – imagine if it doesn’t!).

Why Are We Seeing an Increase in CPNs?

Mandatory Insurer Reporting started January 1, 2012.  Cases settled for more than $100,000.00 must be reported by the defendant to Medicare.  On April 1, 2012 the threshold dropped to just $50,000.00.  This means Medicare’s agents (both CMS and the MSPRC) will find out about all PI settlements over $50,000.00.  If you want to minimize the Medicare liens you should report cases to Medicare before they settle.  Give the date of injury.  Give specific injuries so the Medicare lien is limited to just sued-for injuries.  If you don’t, you’ll get an enormous CPN with just a month to respond.

Mandatory Insurer Reporting must be working, or we wouldn’t see so many CPNs.

Please contact us for any lien resolution support or assistance.  In addition to Medicare lien resolution, we can assist you with Medicaid lien resolution, ERISA subrogation, private insurance companies’ liens, and more.

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.

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