Medicare Conditional Payment Resolution


The Medicare Secondary Payer (MSP) laws require that Medicare conditional payments be reimbursed to Medicare. Failure to do so can result in serious consequences.

Any time a resolving claim involves a Medicare beneficiary, Medicare conditional payment resolution must take place.

Our Medicare Conditional Payment Resolution services include advisement as to when Medicare conditional payments might be an issue, and we perform Medicare Conditional Payment Verifications to determine what, if any, conditional payments were made by Medicare.

Once we receive a Medicare Conditional Payment Verification, we have our team review the diagnostic coding in order to determine which expenses were related to the work injury and which were not. We bring any non-related costs to Medicare’s attention, and we demand that they be excluded from the conditional payments that are to be reimbursed from the settlement proceeds.

Further, we offer to negotiate the amount of the Medicare Conditional Payments based on the amount of the conditional payment and the amount of the settlement. We have found that Medicare might accept a lower amount as full and final satisfaction of the conditional payment. This can reduce costs for our clients. Gordon & Rees has saved clients hundreds of thousands of dollars over the years and we have a seventy-eight percent (78%) success rate with conditional payment resolution. We are also experienced in higher levels of appellate review for Medicare Conditional Payment matters.

Gordon & Rees uses the most current tools possible to offer optimum services in this area. Such tools include the Medicare Secondary Payer Recovery Contractor’s (MSPRC) online web portal and automated telephone line, as well as direct contact to staff and contractors.

The Medicare Conditional Payment services provided by Gordon & Rees include:

  • Medicare conditional payment verifications/investigation
  • Medicare conditional payment disputes and appeals
  • Administrative Law judge conditional payment hearings
  • Federal district court conditional payment resolution
  • Medicare Advantage litigation
  • Preparation of settlement language related to Medicare Secondary Payer issues
  • Medicare Secondary Payer Mediation Services
  • Medicare Advantage resolution
  • Medicaid Secondary Payer services