New MSP Recovery Portal Functionality and Recovery Thresholds Still $750


11/20/2018

By Marty Cassavoy, Vice President of Medicare Secondary Payer Compliance

During this holiday week, it might be easy to miss a CMS update on portal enhancements and 2019 thresholds.

First up, CMS announced that it will hold a webinar to discuss new functionality available in the Medicare Secondary Payer Recovery Portal. The webinar, which will be held on Tuesday December 18, 2018 at 1 p.m. ET, will discuss additional features that will allow authorized users to self-report their own workers’ compensation, no-fault and liability conditional payment “leads.”  At present, conditional payment leads may only be set up by phone, fax, mail or – in the case of recovery in ongoing responsibility for medicals cases – via section 111 reporting.  The new features are scheduled to be released on Monday January 7, 2019. 

CMS and its contractors have updated the MSPRP to incorporate self-service upgrades at the beginning of each of the last two quarters. In July 2018 at the start of Q3 the MSPRP was upgraded to incorporate an “electronic conditional payment letter” feature whereby authorized users could download a real-time PDF of an electronic conditional payment letter. In October 2018, at the start of Q4, the MSPRP was upgraded to allow for “real-time” approval of written authorizations such as letters of authority and proofs of representation.

The lead creation process has long been a pain point regardless of the insurance type. Information describing injuries is often misunderstood and injury information is often lost in translation. These misunderstandings can have a profound impact on the amount of Medicare’s claimed conditional payment amount as well as a potential settlement. We hope this update will provide an opportunity to get this aspect of conditional payment recovery right. We are looking forward to this additional self-service feature and have, along with other stakeholders, found the recent upgrades to be quite helpful. 

To register to participate in the webinar, please click here.

CMS also announced the annual recovery threshold computations. Once again, CMS announced no changes in this important area. The 2019 recovery and reporting thresholds will remain at $750 for all insurance types. This means that neither section 111 reporting nor recovery activities will be required for any liability, workers’ compensation or no-fault settlement for $750 or less.  

We welcome CMS’ decision to leave this threshold unchanged. A copy of the report announcing the threshold can be found here. For any questions on either of these items, please contact ExamWorks Clinical Solutions Vice President of MSP Compliance, Marty Cassavoy, at marty.cassavoy@examworks-cs.com or 781-517-8085.

About Marty Cassavoy

Marty Cassavoy is the Vice President of MSP Compliance at ExamWorks Clinical Solutions.  Marty and his team develop solutions to challenges in all areas of Medicare Secondary Payer compliance and across all insurance types.  An attorney licensed to practice law in Massachusetts, Marty works in ExamWorks’ Woburn, Massachusetts office and can be reached at 781-517-8085 or marty.cassavoy@examworks-cs.com

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