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What is the Fixed Percentage Option?
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This option provides certain Medicare beneficiary's with an alternative to resolving Medicare's recovery claim by paying a flat 25% of his/her total liability insurance (including self-insurance) settlement instead of following the traditional recovery process. In order to qualify for the Fixed Percentage Option, all of the criteria below must be met:

  1. The liability insurance settlement must be for a physical trauma based injury (i.e., it does not relate to ingestion, exposure, or medical implant).
  2. The total liability settlement, judgment, award, or other payment is $5,000 or less.
  3. The beneficiary elects the option within the required timeframe:
    • The request must be submitted before or at the time the settlement documentation is submitted.
    • If a Conditional Payment Notice (CPN) has been issued, the request must be on or before the CPN response is due (30 days from the date of the CPN).
  4. Medicare has not issued a demand letter or other request for reimbursement related to the incident.
  5. The beneficiary has not received and does not expect to receive any other settlements, judgments, awards, or other payments related to the incident.

How to elect this option

  1. In order to elect this option, the following Medicare Secondary Payer Recovery Portal (MSPRP) field requirements must be met:
    1. Case Information Page
      Field Requirement
      Case Type Must be Liability Insurance
    2. Settlement Information Page
      Field Requirement
      Injury Type Traumatic Injury
      Settlement Amount Traumatic Injury
      Settlement Date
      • Must be entered
      • Must be less than or equal to $5,000
      Fixed Percentage Option Must be selected
      MED/PIP/Other Exclusions Cannot be entered
      Attestation Must be checked
  2. Documentation must be completed by the beneficiary or the beneficiary's representative, and uploaded to the case using the Upload Documentation link found on the Settlement Information page. The submitted documentation must include the required data outlined in the document found at the following link.

Next Steps

Requests are processed in the order received. Please allow the Centers for Medicare & Medicaid Services (CMS) 30 days to process the request.

If the request is denied, a formal letter will be provided with an explanation, and a regular Final Demand Letter will be sent under separate cover. If the request is approved, the beneficiary will receive a bill for the amount specified (i.e., 25% of the settlement).