CMS announced it will maintain the existing $750 reporting and recovery thresholds for physical trauma-based liability settlements and for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibly for medicals. Settlements of $750 or less are exempt from conditional payment recovery as well as Section 111 reporting, notwithstanding ORM reporting obligations.
Section 202 of the SMART Act requires CMS to assess annually the costs it incurs in collecting Medicare conditional payments versus the amount collected for the purpose of setting a threshold settlement amount whereby the expected conditional payment amount to be collected is more than the cost of collection. In determining the 2018 thresholds, CMS found the estimated cost of collection per Non-Group Health Plan case was approximately $323. The $323 was then compared to the average demand amount per settlement range for liability cases, which is $417.79 and $300-$500 for workers’ compensation and no-fault cases. CMS analysis supports the determination to keep the thresholds at $750 for 2018.