Conditional Payment Services

For injured individuals already on Medicare, conditional payments (also commonly known as Medicare liens) should be researched with Medicare and analyzed prior to settlement to ensure that there are no unaccounted expenses. PMSI offers various services to assist clients with obtaining the conditional payment amount as well as disputing any unrelated charges asserted by Medicare. Failure to consider conditional payments prior to settlement can result in numerous consequences
for all parties involved in the settlement.

Our many years of experience have taught us that clients handle the verification of conditional payments in various ways. For this reason, PMSI does not automatically include these services at the time an MSA allocation is completed, as some claims professionals choose to personally handle the verification process, while others prefer to have PMSI’s experienced professionals provide assistance. Either way, PMSI can ensure you remain in compliance while helping to reduce costs by providing analysis and support to lower conditional payments if they exist.

Conditional Payment Verification Service
PMSI can manage the correspondence with the Medicare Secondary Payer Recovery Contractor (MSPRC) to determine if conditional payments exist, including the tracking and follow-up on the request. PMSI will provide written documentation listing the conditional payments made or confirming that no conditional payments exist. The Conditional Payment Verification Service helps to alleviate administrative burden for busy claims professionals.

Conditional Payment Analysis Service
When conditional payments exist, PMSI’s dedicated Specialists can review the payment summary and perform a detailed analysis to identify questionable charges and recommend a reduction. The analysis consists of reviewing all file materials including medical records, settlement documents, and other legal evidence. PMSI provides written documentation of any disputable charges and provides recommendations for resolution or a reduction of the conditional payment amount. If the client decides to pursue a dispute/appeal, PMSI will work with the client and the Medicare Secondary Payer Recovery Contractor (MSPRC) in order to reduce the total conditional payment amount.