CMS Issues Second Alert Clarifying $1,000 Reporting and Conditional Payment Recovery Amount Threshold for Liability Only

In conjunction with the alert report for February 18th, CMS provided additional clarification that the change in Threshold is  limited to physical trauma-based liability insurance settlements.  (Note: This threshold does not apply to settlements for alleged ingestion, implantation or exposure cases.)

The  new threshold is effective immediately. This means that physical trauma-based liability settlements of $1000 or less do not need to be reported and recovery of Medicare’s conditional payment amount from these settlements will not be pursued.

Information on the methodology used to determine this new threshold is provided at http://cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/Computation-of-Annual-Liability-Insurance-Settlement-Reporting-and-Recovery-Threshold.pdf.

The Alert supersedes the content of the existing Medicare Secondary Payer Mandatory Reporting Non-Group Health Plan User Guide (Version 4.1), and will be incorporated into the next version of the User Guide.

(Note: The CMS will pursue recovery of any demand issued prior to the date of this Alert.)

See the details of the second alert at http://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/Downloads/New-Downloads/Alert-Change-in-Reporting-Threshold-for-Certain-Liability-Settlements-Judgments-Awards-or-Other-Payments.pdf

There is no change in the threshold for workers’ compensation in the Alert.

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