Self Calculated Conditional Payment Options

The Medicare Secondary Payer Recovery Contractor (MSPRC)

published further guidance pertaining to the Self-Calculated

Conditional Payment Option on January 16, 2012. Beneficiaries now have

the ability to calculate conditional payment liens in liability cases under certain

circumstances. The option can be exercised beginning February 21, 2012.

The case must first be reported to the COBC contractor, and it must involve:

    • A physical trauma,
    • The total settlement cannot exceed $25,000.00,
    • The date of accident must have occurred at least six months

prior to the request for conditional payment information and

  • The beneficiary must demonstrate that medical treatmenthas been completed and that no further care is expected.

This can be demonstrated by:

  • A written physician attestation or
  • A certification by the beneficiary that no care has been received in the previous 90 days and that thebeneficiary expects no further care.

If the beneficiary is eligible for the self-calculated option, any

appeal of the amount requested is waived but the beneficiary

retains the right to pursue a waiver of the recovery.

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