News

May 03, 2011

Greater delays in obtaining conditional payment information should be expected following MSPRC’s recent announcement that it has suspended issuance of Rights and Responsibilities letters and Conditional Payment Demand Letters.  This change in protocol is presumably in response to an Arizona federal court’s recent opinion in the case of Haro v. Sebelius, where the court ruled that reimbursement cannot be demanded by the government until any disputes or requests for waiver of the conditional payments have been brought to disposition.  To allow otherwise, the court noted, would have a chilling effect on a party’s right to appeal its liability for reimbursement of conditional payments.

Before Haro, MSPRC demanded reimbursement of conditional payments within 60 days from the time it issued its final demand letter.  This was true even if an appeal or dispute of the charges remained pending.

In the wake of the Haro decision, MSPRC is now reviewing its internal policies and procedures before issuing any additional conditional payment demand letters.  MSPRC has not provided any timeline for when it will resume issuing conditional payment information.

Wiedner & McAuliffe, Ltd. will continue its practice of addressing potential Medicare issues at the earliest stage of every case.  Given the inherent delays in securing information from CMS and MSPRC, requests for conditional payment itemizations should be made as soon as reasonably determined that a claimant may be a current Medicare beneficiary.  A Consent to Release and Social Security Administration authorization should be directed to the claimant or his/her counsel in all cases involving a person 65 years of age or older, and in cases in which there is a suggestion that the claimant may have filed an application for Social Security Disability benefits.  While awaiting a response from MSPRC can be a frustrating ordeal, early recognition of Medicare issues serves to prevent unnecessary delays in the final stages of a case.

We will continue to keep you advised on this topic, as well as any other significant Medicare Secondary Payer Act developments.