PMSI has been informed that the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments has resumed issuing Demand letters as of June 27th. Copies of the revised Demand letters are available on the MSPRCMedicare Secondary Payer Recovery Contractor - responsible for verification of conditional payments website.
PMSI has noted that the most significant changes to the Demand letter are as follows:
- The addition of language stating that Medicare will not initiate any recovery action while a request for an appeal or waiver of recovery is pending.
- If an appeal or waiver request if filed, the responsible party may elect to repay Medicare the full amount or the amount that is believed to be owed to Medicare within 60 days to avoid the assessment of interest (interest accrues on any unpaid balance which may include any amount owed to Medicare once a final decision is reached).
- If Medicare intends to take collection action, including referral to the Department of Treasury, appropriate notice will be provided.
The above noted changes appear to be in response to the recent case Haro v. Sebelius where the Arizona District Court found that Medicare’s application of the 60-day reimbursement requirement to support immediate collection activities against beneficiaries when the reimbursement claim is in dispute is neither rational nor consistent with the statutory scheme providing for waiver and appeal rights. For a full summary of the Haro v. Sebelius case click here.