Conditional Payment Negotiation & Resolution

Mitigate Costs and Reduce Future Exposure

Medicare Conditional Payments are payments made by Medicare on behalf of a Medicare beneficiary for medical treatment which should have been paid for by a primary payer. Whether the payments have been made because the insurance claim was unknown or in dispute, these payments must be reimbursed to Medicare or interest and potentially double damages may apply pursuant to a federal statute.

We advocate on our clients’ behalf to comprehensively address the complex Medicare Conditional Payment Recovery Process. We begin first by identifying the payments Medicare has made, handling all negotiations with either the Benefits Coordination and Recovery Center (BCRC) or the Commercial Repayment Center (CRC), and aggressively pursue the best resolution for each case scenario.

Consultative Approach

We take a consultative approach and partner with our clients to tailor any of our existing programs to best suit their needs. Our process includes:

  • In-depth analysis of all dates of service and diagnosis/CPT codes
  • Identification of charges that are not related to the claim
  • Creation of all disputes and appeals addressing conditional payments identified, including any services unrelated to the industrial injury, illness, or condition
  • Aggressive negotiation regarding all identified and unrelated conditional payments, through all levels of appeal until resolution

    “I love sending you referrals. I think your company does a fantastic job and is very quick, efficient, and knowledgeable.”

    Senior Examiner

    Novato, CA