Conditional Payment Services


NuQuest/Bridge Pointe has been providing our customers with proven and cost effective Medicare conditional payment services for the past decade.  Medicare has strong enforcement rights regarding conditional payments and can pursue multiple parties for conditional payment reimbursement, including “double damages” against primary payers if its interests are not properly protected.

We are experienced with all facets of CMS’ conditional payment procedures and offer Conditional Payment Investigation and Negotiation services to assist our customers in addressing this important MSP compliance obligation.

 

Through these services NuQuest will self report cases involving Medicare beneficiaries to the Coordination of Benefits Contractor (COBC); flagging Medicare's database regarding the injury may lessen future conditional payments made by Medicare.  Requesting a conditional payment estimate from the Medicare Secondary Payer Recovery Contractor (MSPRC) allows us to confirm treatment is being sought through the primary payer and ensure that only payments related to the injury/incident are identified as a conditional payment.
 

Medicare Conditional Payment Claim Investigation

Services include:
  • Social Security and Medicare status determination
  • Registered Nurse review of medical records to identify related diagnoses
  • Reporting of case demographics and related diagnoses to the Medicare COBC
  • Request for a Claim Payment Worksheet outlining the details of Medicare’s conditional payments, if any

Medicare Conditional Payment Claim Negotiation

Services include:
  • Review of Medicare’s Conditional Payment Worksheet and related medical records and/or claim payouts
  • Provision of recommendations regarding the appropriateness of Medicare’s claim
  • Submission of a request for removal of any inappropriate claims to the MSPRC