Keeping Up With Conditional Payment Obligations: Effective Strategies For Medicare Conditional-Payment Recovery Cost Containment

Compliance with the Medicare Secondary Payer Act (MSP) in a workers compensation, general liability, or no-fault settlement requires a multi-faceted approach to satisfy three pillars—past, present, and future—of protecting Medicare’s interest.

These three pillars can be broken down simply when parties are nearing the end of settlement negotiations with Medicare beneficiaries.

Protecting Medicare’s past interests involves reimbursing Medicare for medical payments it made related to the claim prior to settlement, also known as conditional payments.

Regarding present obligations at the time of the claim/settlement, responsible reporting entities (RREs)—typically the workers compensation, general liability, or no-fault plan/carrier—must submit certain required claim/settlement information via Medicare, Medicaid, and SCHIP Extension Act (MMSEA) Section 111 Reporting to Medicare to facilitate the coordination of benefits and recovery of conditional payments as it relates to that Medicare beneficiary’s claim.