We recently learned from Linda Lipsen, CEO at AAJ that:
The Centers for Medicare & Medicaid Services (CMS) have released guidelines to provide certainty and finality when it comes to conditional payments. These guidelines — which will initially be implemented in claims with a total settlement value of $25,000 or less — will enable you to receive a final number from CMS about how much is owed prior to settlement.
The parties can self calculate how much they believe they owe CMS and provide CMS with that number.
CMS will review this information and determine its accuracy.
CMS will then provide a final demand letter within 60 days of a request by the beneficiary or his or her attorney.
The final demand from CMS will be considered reliable and final if settlement occurs within 60 days of the date the final demand letter is issued.
Full instructions on how to calculate the amount of Medicare’s conditional payment will be available at www.msprc.info by January 15, 2012.
The option of obtaining a conditional payment amount will be available in February 2012, for certain settlements involving physical trauma based injuries where treatment has been completed. Criteria for using this option includes:
- The settlement does not relate to ingestion, exposure, or medical implant;
- The incident occurred at least six months before the beneficiary submits his proposed conditional payment amount to Medicare;
- The beneficiary demonstrates that treatment has been completed and no further treatment is expected either through a written physician attestation or by certifying in writing that no medical treatment related to the case has occurred for at least 90 days prior to submitting the proposed conditional payment amount to Medicare.
The claim amount of $25,000 is considered a starting point. CMS stated that the claim amount will increase. We expect the next phase-in in approximately six months.
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