Monday, February 8, 2010

Time Frame for MSPRC Correspondence

I have a client who has a large Medicare lien. We settled the case on the premise that a jury would have attributed 30% of fault to our client. After settlement we sent a letter to MSPRC advising of the settlement, our costs and expenses. The lien amount was only reduced by 10% with no reduction for our fees and expenses. I sent a letter of appeal citing the statutes which require reduction for procurement costs. We paid the full amount of the lien under protest to avoid interest charges. I just received a letter advising the full amount of the lien had been paid and the file was closed. I called to ensure the appeal was on file. I was advised the request for "compromise" had been sent to the regional office. She went on to advise that the regional office has no time limit by which these compromise requests must be processed. She also refused to give me any contact information for the regional office. Do you know if there is a time limit on this? I understood I had filed an "appeal" not a "compromise request" do I need to re submit an "appeal"? Any assistance would be appreciated. Thank you.

Kansas Attorney

Unfortunately, what you are experiencing is not uncommon. Under the current process, all correspondence is scanned in Detroit and put in "buckets" based on how the correspondence is either labeled or the language in the first one or two sentences of the letter.

When the MSPRC miscalculates the final demand amount then a request for "redetermination" must be made. Based on the facts you provided it appears that when you requested an "appeal" the MSPRC labeled your letter as a “compromise" and forwarded it to the Regional Office in Kansas City. The CSR you spoke with at the MSPRC was correct in that there are no time limits associated with a compromise request; however, it has been our experience that it usually takes approximately 30-60 days for a decision.

Although; this is an unfortunate situation all is not lost. I suggest calling the MSPRC again and ask to speak to a supervisor and explain the situation, that you want Medicare to make a "redetermination" of their final demand based on their error of not correctly applying the procurement offset. The MSPRC can and should pull your letter and work it at the MSPRC level, it does not need to be done by the Regional Office. Also request that she expedite your request due to their error. The timeframe for a redetermination decision is 60 days from the date of receipt.

Should you need the contact information for the Kansas City Regional Office, please contact me directly and I will be happy to provide you with it.

Mary Skinner