On July 19, 2024, the Centers for Medicare & Medicaid Services (CMS) created a new reference guide which will be referred to as, Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) Beneficiary Reference Guide version 1.1.

The update provides details on the process of recovering conditional payments from the Medicare beneficiary, which typically involve the following steps:

1. Reporting the case to the BCRC
2. BCRC issues a Rights and Responsibilities letter
3. BCRC identifies Medicare’s interim recovery amount and issues the CPL
4. BCRC issues a Conditional Payment Notification (CPN)
5. Dispute Process
6. BCRC issues a recovery demand letter
7. Assessment of Interest and Failure to Respond
8. Referral of debt to the Department of Treasury

For further details on the steps of recovering conditional payments, visit CMS’ website here. To download the Non-Group Health Plan (NGHP) Medicare Secondary Payer (MSP) Beneficiary Reference Guide Version 1.1 by clicking here.

DISCLAIMER:

This guide is intended to provide Medicare beneficiaries with a reference manual to help them navigate the Medicare conditional payment recovery process. It is in no way intended as an exhaustive, step-by-step guide, nor is it intended to replace, supersede, or otherwise contradict any existing policy or procedural guidance. If anything in this manual appears to create ambiguity or to alter an existing process or obligation in any way, we recommend that the reader seek further guidance.

For Additional Information

Medivest will continue to monitor changes occurring at CMS and will keep its readers up to date when such changes are announced. For questions, feel free to reach out to the Medivest representative in your area by clicking here or call us direct at 877.725.2467.