CMS recently released an NGHP Beneficiary Appeals Reference Guide. This valuable resource explains how a Medicare beneficiary claimant, their attorney or another authorized representative can work with the Benefits Coordination and Recovery Contractor (BCRC) to resolve Medicare conditional payment demands.

This informative document details how and when CMS recovers Medicare conditional payments from claimant Medicare beneficiaries in workers’ compensation, no-fault and liability claims.

The NGHP Beneficiary Appeals Guide is a helpful and comprehensive roadmap to the specifics of post-settlement Medicare conditional payment recovery from a claimant Medicare beneficiary. It covers the recovery process, pre-demand calculation options, the appeals process and payment methods. In addition, an appeal submission example and other sample letters are provided.

For cases involving conditional payment recovery from payers, CMS offers the NGHP Applicable Plan Appeals Reference Guide to the resolution of demands from the Commercial Repayment Center (CRC).

We commend CMS for creating this guide to help payers, attorneys, and Medicare beneficiaries better understand the Medicare conditional payment recovery processes and their rights and responsibilities during settlement.

As always, Tower is ready to help you with any conditional payment, Medicare Secondary Payer compliance, or Medicare Set-Aside issue. We especially enjoy your challenging cases! Contact Chief Compliance Officer Dan Anders at daniel.anders@towermsa.com.