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. For the last two years 2017-2018, CMS has maintained the threshold of $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 2019 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.

CMS has additionally posted an Alert regarding an upcoming MSPRP webinar: November 19, 2018 – Webinar for Upcoming Enhancements to the Medicare Secondary Payment Recovery Portal (MSPRP): Effective January 7, 2019, new functionality will be added to the MSPRP that will allow authorized users to self-report, Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) leads. CMS will host a webinar on December 18, 2018 to provide additional information on this enhancement. Complete webinar information is posted in the Downloads section below.

Please contact us if you have any questions on the foregoing announcements.


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