Timing Makes a Difference

When it comes to Medicare Secondary Payer Act (MSPA) compliance, timing can make a world of difference. From Medicare conditional payment claims to Set-asides, it is important to start addressing issues early in the settlement process. Doing that will lead to a much greater level of overall success.

With regard to Medicare conditional payment claims, notifying Medicare before settlement will allow time to thoroughly review and dispute claims that may be inappropriately asserted. We have found that, when we begin this process early, we are able to achieve between 90 to 100 percent reduction in conditional payment claims in many cases.

Similarly, when a Medicare Set-aside or Liability Settlement Allocation is appropriate, reviewing the medical records prior to the beginning of settlement discussions allows an opportunity to work with physicians on pending medical issues, obtain additional records and accomplish other tasks to reduce the amount of money that should be designated for future medical expenses. This is particularly important when cases will be submitted to CMS for approval.

Beginning to address MSP issues early in the settlement process aids in making sure that all parties are on board with protecting Medicare when necessary. It allows for discussions to take place and agreements to be drafted that clearly evidence the intention of everyone to comply with the MSPA. Failing to handle these issues appropriately can lead to substantial headaches down the road.

If you have any questions or need assistance with any MSP issue, please let us know. We are always happy to help.