We have recently experienced an increase in errors by COBC and/or MSPRC in processing information and conditional payment summaries related to liability claims and lawsuits. Each entity blames the other for these mistakes. Examples of errors include, but are not limited, to the following:
- COBC opening a file under the wrong name and/or Medicare number, despite correct information having been provided;
- COBC and/or MSPRC receiving a new claim file, then not processing it for months, as it “falls through the cracks”;
- An increasing number of unrelated charges have been appearing on interim and final conditional payment summaries, often requiring extensive communication with MSPRC to obtain correction; and
- Letters from COBC and/or MSPRC incorrectly denying a beneficiary’s Medicare eligibility, while at the same time sending us another letter notifying us of conditional payment amounts for that same beneficiary.
BEAT PRACTICE TIPS
The best way to limit processing errors is to communicate regularly with MSPRC, something our office monitors closely in every MSP matter we handle, whether we are retained by the defense or by the beneficiary’s counsel. If our office has not been provided with a Consent by the claimant or their counsel, we are not able to head-off these errors until after a Consent is received, which sometimes does not occur until after settlement. Unfortunately, delaying the provision of a Consent may significantly and unnecessarily delay disbursement of settlement proceeds to the beneficiary at the end of a matter. We find the attorneys who are willing to work with our office, and with whom we communicate openly and regularly, often achieve the best results.
Other suggestions to ensure success include:
- Allowing our office to assist the beneficiary – or the beneficiary’s counsel – with the Medicare portion of his/her claim early on will help to avoid unwanted delay in disbursement of monies at the conclusion of the matter.
- Good communication and review of the injury information with either the beneficiary or his/her attorney is helpful to ensure consistency in reporting the claim to COBC and MSPRC. Beneficiaries and their counsel should avoid over-inclusion of disputed and as-yet-uncertain injuries/treatment, which can lead to much larger demands to a beneficiary for reimbursement of what the parties may ultimately agree are unrelated injuries and treatment. If additional injuries Are determined to be “related” after a matter is reported to COBC/MSPRC, that information can always be provided when notice of settlement/resolution is provided to MSPRC prior to preparation of a final demand
- Provide accurate and complete information at the beginning of a matter including: an accurate description of injuries, accurate home address, date of birth, date of loss, and Medicare number for the beneficiary.
- If you are having difficulty with a processor while on the phone with MSPRC, end the call and try back with another processor. Some are helpful, some are not. Don’t spend time getting frustrated with a processor who does not appear to know what he/she is doing. You may be given inaccurate information anyway.
- Get a Medicare Case ID# whenever possible; this number is not the beneficiary’s Medicare number or Social Security Number, but is an internal CMS/COBC/MSPRC number which appears on all correspondence concerning an MSP claim or lawsuit. It may be helpful in allowing access to limited information via the MSPRC Portal.