The Centers for Medicare & Medicaid Services (CMS) consolidated all of the functions and workloads related to Medicare Secondary Payer (MSP) post-payment recoveries into one MSP recovery contract – the new national MSP Recovery Contractor (MSPRC). The MSPRC’s website provides tools and resources to assist in the MSP recovery process.

The MSPRC recently presented a PowerPoint presentation regarding changes to its recovery process. View it here. The presentation features the following information:

• the new Rights and Responsibilities letter for Medicare beneficiaries;
• the Conditional Payment Letter (CPL) process and timeline;
• the new Conditional Payment Notice (CPN) process and timeline;
• what to provide MSPRC when there is a settlement, judgment, award or other payment;
• the recovery Demand Letter process and timeline; and
• new additions and changes to the MSPRC Recovery Process.

CMS’s Reporting Dos and Don’ts

To avoid common reporting mistakes, please regularly check CMS’s Reporting Dos and Don”ts page. CMS updates this page with reporting issues and errors it has identified.

Revised CMS Alert Regarding the Collection of Identifying Information

The following document may be helpful if you receive questions about the collection of Social Security Numbers or Medicare Health Insurance Claim Numbers:

CMS ALERT Regarding the Collection of Medicare Health Insurance Claim Numbers (HICNS), Social Security Numbers (SSNs) and Employer Identification Numbers (EINs) (Tax Identification Numbers)

May 2010 Medicare Secondary Payer Act Cases

Discovery To Proceed in Case Challenging MSP Reimbursement Procedures (Arizona Federal)

The federal judge granted plaintiffs’ motion to compel discovery in the pending potential class action against the U.S. Department of Health and Human Services (HHS). Plaintiffs challenge the collection practices used to recover Medicare reimbursement claims under the Medicare Secondary Payer (MSP) program.

HHS refused to make initial disclosures under Fed.R.Civ.P. 26(a)(1)(B)(I) maintaining that discovery was inappropriate, except for filing the administrative record. The court issued an order directing the parties to brief the scope of the discovery question. Plaintiffs filed a motion to compel discovery beyond the administrative record, and HHS filed a motion to limit judicial review to the administrative record. In support of its motion, HHS relied on 42 U.S.C. § 405(g), which applies to a case where a beneficiary seeks juridical review of an agency’s denial of a claim for benefits. The court held that this statute is not applicable to this case, which is a due process claim. The court will review HHS’s decision to adopt the policies and procedures challenged by plaintiffs, not decisions resolving individual MSP claims. The court will determine the following issues in this case:

1. whether HHS can require prepayment of an MSP recovery claim before the correct amount is determined through the administrative appeal procedures; and
2. whether HHS can make plaintiffs’ attorneys financially responsible if they do not hold or immediately turn over to HHS their clients’ litigation proceeds.

Date of Decision: April 12, 2010

Haro v. Sebelius, 2010 U.S. Dist. LEXIS 38620, CV 09-134-TUC-DCB (D. Ariz. April 12, 2010) (Bury, J.).