Gina Cox No Comments


The image you see here is NOT a bill.  Do NOT send a check to Medicare.

Although the Benefit Coordination and Recovery Center (BCRC) and the Commercial Repayment Center (CRC) have advised against paying Conditional Payment Letters (CPL) and Conditional Payment Notices (CPN), Insurers, Responsible Reporting Entities (RRE), attorneys and claimants still keep writing checks.

CPLs and CPNs are not bills.

Medicare sends CPLs and CPNs to inform parties of bills they have paid that they believe to be related to the reported claim. Their intent is to put you on notice and to give the interested party an opportunity to review the charges.

A CPN has a response timeframe. The responsible party has 30 days to review the charges and respond to Medicare. If no response is received, Medicare will then issue a Final Demand Letter (FDL). The Final Demand Letter IS a bill. Medicare expects payment once they issue the FDL, but not before.

A CPL is a snapshot in time. It is a statement of all the bills that Medicare has received and paid that they believe to be related to the claim as of the date of the letter. It could change tomorrow or next week. A CPL has no response timeframe. The RRE or responsible party does not need to respond or contact Medicare unless they disagree with the charges or believe that the information Medicare has on file is incorrect.

On both the CPN and CPL, Medicare states “Please also be advised that we are still investigating this case file to obtain any other outstanding Medicare conditional payments: therefor, the enclosed listing of current conditional payments is not final.”

CPLs from the BCRC go on to state, “We request you/your attorney refrain from sending any monies to Medicare prior to submission of settlement information and receipt of a demand/recovery calculation letter from our office.”

What happens if you do pay a CPL or CPN?

If you do send a check based on a CPL or CPN, Medicare is required by law to cash the check. They will accept your money or they will return your check. Unfortunately if they cash the check, the money is deposited into Medicare’s general account and is not credited to the beneficiary since no formal request for payment or bill has been issued. If/when a FDL is issued, Medicare does not have the technology to match the current demand or bill with a previously posted check.

It can be confusing and costly when the RRE receives the FDL and ignores it because they think “I already paid Medicare.” Meanwhile, Medicare issues an Intent to Refer letter because they have not received payment in a timely manner.

Do not cause yourself unnecessary headaches. Do not pay a CPL or CPN. Take Medicare seriously when they say, “THIS IS NOT A BILL. DO NOT SEND PAYMENT AT THIS TIME.” Wait for the Final Demand.

At Flagship Services Group, Conditional Payment Resolution is our specialty. We understand the process. We work closely with both the BCRC and the CRC so we submit the appropriate documentation at the appropriate time and get the best results for our clients by making sure they pay Medicare what they owe, but not a penny more. Learn more about Conditional Payments and contact us to see how we can help you.


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