Compliance with the Medicare Secondary Payer Act: What's New?

I know that Medicare does allow an "attorney fee" as a cost to be deducted from the initial Conditional Payment Amount. This would be a simple matter to calculate if the client actually paid a flat or hourly fee for this service. However, how is this handled when the fee arrangement is, as is standard in injury claims, for a contingent fee? Is the deduction even available for such a fee, since the client is not actually paying that amount out of pocket but rather it is being deducted from the gross settlement amount? If it is, how is it calculated and deducted from the initial C.P.A.? Thanks. PP

The Medicare A/B conditional payment amount is reduced proportionately for attorney’s fees and costs; not dollar for dollar. Example: If the combined fee and costs paid by the client are 42%; the final demand amount for the A/B conditional payment amount will be reduced proportionately by 42%.

I still don't understand why M.S.P.R.C./C.O.B.-R doesn't also include the advantage plan (i.e. Part C) carrier, if any, in their lien search for the Conditional Payment Amount. It's getting where it's almost not worth taking personal injury claims where the client has Medicare. There's just too much work and risk involved. smh.

At this time there is no national contractor for Part C and D lien recovery. This is because the Part C and D plans are administered by private health companies and all billing information for these plans is located on the billing systems/programs for the individual companies running the plans. It is not feasible to sync up all these different systems and platforms. So unfortunately I do not see obtaining Part C and D lien information getting any easier any time soon.

Any tips on accessing the Patient Portal on the website? A few years ago it was fairly simple. Now it seems they want all kind of verification of ID by the attorney to gain access to a case, inc. making a phone call to Experian, etc. I don't understand the "ID paranoia" of late by Medicare.

There is a patient portal for medicare recipients that the Medicare beneficiary creates on Medicare.gov. This patient portal gives some access to conditional payment data located in the MSPRP portal. In order for an attorney to access the Medicare beneficiary’s account they must have written permission from the beneficiary and have the user name and password the beneficiary established for their account. If an Attorney (or any person) would like to gain access to conditional payment information on the MSPRP they must be properly vetted by the federal government. No access to the MSPRP portal will be provided until proper vetting takes place. And an additional, higher vetting level, is required to obtain copies of letters and see detailed lien information. The vetting system for the MSPRP has been in place for several years and has not changed.