Medical Conditional Payments

Conditional Payment investigation and negotiation: the other half of true MSP compliance.

While demanding an advocate’s Medicare Set Aside (“MSA”) is crucial to MSP Compliance, it is only half of the Medicare Compliance challenge. Conditional payments, Medicare’s payment of Medicare services for covered individuals, must be investigated in order to understand the extent of your liability under the statue.

Without investigation and discovery of Medicare’s Conditional Payments on a particular claim, you could run the risk of miscalculating the necessity of CMS submission or being blindsided by a Medicare lien post settlement.

At Crowe Paradis, we not only investigate your conditional payment obligations but also include this service at no extra charge. Some of our competitors don't pursue conditional payment investigations at all. Most of our competitors make discovery of this liability optional.

In addition, we believe that merely reporting the amount Medicare claims they are owed in conditional payments is not enough.  We believe true Medicare compliance demands an advocate's approach to seeking opportunities for negotiation and cost mitigation. While Medicare provides its conditional payment information in good faith, errors can be found in several aspects for their calculations. A few examples from our successful negotiations reveal the value in reviewing the rationale behind the numbers.

At Crowe Paradis, we take a very aggressive approach to conditional payments. Our conditional payment investigation and reduction program is a proprietary process. We focus on investigating the amount claimed and negotiating with CMS based upon legal principles outlined in the Code of Federal Regulations, the Medicare Intermediary Manuals, as well as State and Federal Law.

We have a talented team of attorneys, nurses, and former conditional payment recovery contractors who collaborate to maximize savings on these claims. With a contingent fee basis, our clients have nothing to lose and everything to gain.