CMS has released a fact sheet detailing the new process for workers’ comp carriers and other insurers to challenge what the agency seeks to recover in conditional payments. The new four-step procedure for challenges went into effect April 28th, 2015. Applicable plans for appeals (including workers’ compensation, no fault insurance and liability insurance) were determined by rule in February of this year. The process is described by CMS in their fact sheet as follows:
- An “initial determination” (the MSP recovery demand letter),
- A “redetermination” by the contractor issuing the recovery demand,
- A “reconsideration” by a Qualified Independent Contractor,
- A hearing by an administrative law judge (ALJ),
- A review by the Departmental Appeals Board’s Medicare Appeals Council, and
- Judicial review.