Spotting the Pitfalls: Understanding Medicare Treasury Claims and Learning How to Avoid Them

The increasing number of U.S. Department of Treasury actions regarding delinquent Medicare Part A and B conditional payment claims is a growing challenge facing non-group health plans (NGHPs). A recent report from the Centers for Medicare & Medicaid Services (CMS) found, in part, that Treasury collections jumped from $55 million in 2020 to $82 million in 2021, a 47% increase. With Treasury collections on the rise—and real dollars at risk—insurers must better understand Treasury actions and build strategies to reduce risk.

The important first step is understanding how Treasury claims arise in the first place. In general, this happens when a CMS conditional payment demand is not timely paid or resolved and becomes delinquent. When CMS issues a conditional payment demand, the debtor has 60 days to issue payment. If payment is not issued within the 60-day period, then the debt is considered delinquent by CMS and, if it remains delinquent for more than 120 days, CMS can refer the debt to Treasury.