Conditional Payments

A conditional payment is a payment for medical treatment made by Medicare on behalf of a responsible party, including workers’ compensation and general liability payers. The Commercial Repayment Center (CRC), Medicare’s conditional payment recovery contractor as of October 5, 2015, seeks reimbursement from the responsible party.

Conditional payment issues can prolong the life of a claim, delay Medicare Set-Asides and deliver expensive settlement surprises. Since Tower is in the settlement business, we proactively search for conditional payments, quickly respond to conditional payment notices and resolve any issues early in the claim. Our sophisticated technology automates much of the process, and our legal and clinical specialists do the rest.

Various triggers prompt us to initiate a conditional payment search:

  • S 111 Reporting data
  • Client request for an MSA
  • Client notification that a claimant is a Medicare beneficiary

When conditional payments are identified or CRC issues a conditional payment notice, we preemptively negotiate reimbursement. The process involves:

Medicare Conditional Payment Claim Investigation

  • Social Security and Medicare status determination
  • Registered Nurse review of medical records to identify related diagnoses
  • Reporting of case demographics and related diagnoses to Medicare’s conditional payment contractor
  • Request for a Claim Payment Worksheet outlining the details of Medicare’s conditional payments

Medicare Conditional Payment Claim Negotiation

  • Review of Medicare’s Conditional Payment Worksheet and related medical records and/or claim payouts
  • Provision of recommendations regarding the appropriateness of Medicare’s claim
  • Submission of a request for removal of any inappropriate claims

Tower Clients Benefit From:

  • An expedited conditional payment process that swiftly moves claims toward settlement
  • Measurable return on investment. Last year, clients saved an average of 96% from Medicare’s original payment demands.

Tower MSA Partners aggressively pursues the optimum conditional payment solution for each case. Find out how our proactive approach can reduce your conditional payments. Call 888.331.4941, email info@towermsa.com, or refer a claim.