As required by section 202 of The SMART Act, CMS is required to annually review its costs relating to recovering conditional payments as compared to recovery amounts. Last year in 2016, CMS announced that the threshold would be $750 across all non-group health plan (NGHP) lines of business- workers’ compensation, liability, and no-fault insurance.
The threshold means that if the TPOC amount is $750 or less, the claim does not need to be reported to Medicare and parties do not need to be concerned with reimbursement of conditional payments. CMS has announced that the threshold for 2018 will remain at $750, therefore, no changes to reporting/conditional payment practices are necessary at this time. We will monitor for a potential update in the threshold amount next November. Please contact us if you have any questions.

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