Medicare Secondary Payer Recovery Portal “Go Paperless” Webinar Highlights

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By P. Czuprynski

The Centers for Medicare & Medicaid Services (CMS) hosted a webinar to discuss its option for carriers, self-insureds, or their recovery agents to obtain service of conditional payment correspondence by email through the Medicare Secondary Payer Recovery Portal (MSPRP), instead of the traditional method of U.S. Mail.

The MSPRP currently allows users to review Medicare’s conditional payment cases for basic information regarding a particular collection case. The portal also allows parties to upload disputes of conditional payment estimates/notices and demands.  However, if a party is past the usual timeframe to appeal, the portal does not allow uploads for appeal.

Additionally, a user can gain elevated access through multi-factor authentication, which allows the user to download Medicare’s conditional payment letters associated with the claim. These functions allow a user to deal with Medicare’s collections on an individual basis.

The additional “go paperless” function would allow a carrier/self-insured, or their recovery agent, to obtain notification that Medicare has issued correspondence associated with a particular claim. The information is emailed to the Account Manager and Account Designees attached to Section 111 COBSW or a TIN reference file submission (a Recovery Agent can also be included).

A drawback to this feature is that Medicare’s correspondence will only be available to download for 30 days and then become unavailable. A more intuitive feature would allow the parties to pick up the letters during the usual timeframe for appeals. This would allow parties to obtain correspondence until the appeal is due and avoid unwanted collection/referral to treasury.

The usual timeframes to appeal a demand (120 days from receipt) or redetermination (180 days from receipt) will likely apply from the date notification is sent through the “go paperless” function. While this may be the case, it is important to remember alternative administrative remedies such as a reopen request. Per 42 C.F.R. 405.980(c), a reopen request can be made within one year of the demand for any reason, within four years of the demand for good cause, and at any time for a clerical error. This process also challenges the validity of Medicare’s collection.

It is possible that going paperless will benefit a carrier/self-insured, but it seems Medicare has the most to gain by avoiding printing and mailing costs. IMPAXX specializes in these processes, which includes acting as a Recovery Agent for specified customers. We are happy to assist with this discussion and can help you determine whether going paperless is right for you.

We will continue to keep you posted as more develops.