Conditional Payment Management

The Franco Signor approach is designed to deliver information quickly and efficiently to the front-line adjuster. The result – we provide the proper reimbursement information, at the time of settlement, or other disposition of the claim, in order to facilitate rapid claim closure.

Medicare has a right of reimbursement from insurance carriers and self-insureds that settle or otherwise administratively close liability, no-fault and workers’ compensation claims. This process is a challenge to navigate because of the changing Medicare Secondary Payer (MSP) landscape. At Franco Signor, we overcome such obstacles through our advanced data-processing technology, coupled with our unparalleled MSP expertise. We translate complex Medicare compliance requirements into easy to understand steps for repaying Medicare. We manage the entire process from start to finish. We are able to resolve conditional payment matters in industry leading timeframes and deliver substantial savings from the initial demand.

We understand that CMS is serious about conditional payment recoveries. Settlements can no longer leave this important responsibility to the Medicare beneficiary, but must be managed proactively by the primary plan to avoid litigation and financial exposures.

We Understand the Importance of Rapid Claim Closure

Certainty. Confirmation that the Medicare file is closed from future recovery.
Quick Identification. Rapid identification of conditional payments.
Savings. Substantial negotiated savings from the initial CP demand.
Comprehensive. Dispute evaluation and appeal filing included where applicable.
Fast. Final Demand letters in industry leading time frames.
Team of Experts. Dedicated team of Claims, Legal and Clinical experts on your side.

BCRC/CRC Notification/Medicare Verification

Obtaining Medicare beneficiary status and notifying the BCRC of the injury is one of the key steps to initiating MSP Compliance. We will contact the BCRC to verify the claim record is on file with Medicare and if not, report the information. We will then follow up to ensure the claim has been added by the BCRC and transition to the MSPRC (Medicare Secondary Payer Recovery Contractor).

Medicare/Social Security Verification

Medicare benefits may begin at varying times in the life of a claim. Even when a claim may not involve a Medicare beneficiary the claimant’s Social Security status may be important to know. Franco Signor will prepare and file a request with Medicare and the Social Security Administration to determine the injured party’s eligibility status for both Medicare and Social Security benefits.

Conditional Payment Resolution

Medicare is allowed to pay for medical items and services during the pendency of a liability (including self-insurance), no-fault or workers’ compensation claim. When such a claim is settled, or a judgment, award or other payment is secured, Medicare is immediately entitled to reimbursement. Medicare call the payments it is owed “conditional payments”. If such payments are not promptly reimbursed, Medicare can refer the debt to the Department of Treasury who has the authority to levy or litigate against all Parties involved for reimbursement, even double damages.

Conditional Payment Resolution Services include; obtaining the CPL (Conditional Payment Letter), Disputing/Negotiating the CPL, Updating the CPL, and Securing the Final Demand from the Recovery Contractor. Resolving conditional payment issues in an MSP case requires specialized skills and a thorough understanding of the claim, state legislation, and federal regulations. Our team of claims, legal and medical experts will work hand-in-hand with you and your counsel to promptly identify these payments made by Medicare, update it if necessary, negotiate and dispute unrelated recovery amounts, and secure the Demand with the time is right with the MSP Recovery Contractor.

Release and/or Settlement Agreement Review

Our team of in-house attorneys will work with your counsel to review settlement and release language to ensure MSP compliance. The document will be unique, based on the facts of your case, instead of boiler plate form language so commonly provided by others. Since the law makes all Parties to a claim legally responsible to pay Medicare it is in the best interests of all parties to get this document right from the start.

For more information about these services, engage us today at: engage@francosignor.com

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