Reminder: Don’t Miss Deadlines for Disputes and Appeals

Missing deadlines for conditional payment claim disputes and appeals unfortunately provides CMS with an easy opportunity to collect. If a timely dispute is not submitted after CMS issues a Conditional Payment Notice, CMS will automatically issue a demand. If an appeal is not timely filed after CMS issues a demand, CMS will refer the claims to the Department of Treasury for collection. The Department of Treasury may collect from a primary payer by offsetting corporate tax refunds and other funds that may be owed by the government. Unfortunately, some primary payers have ended up with corporate tax refunds offset simply because an appeal was never filed.

CMS is supposed to issue a Conditional Payment Notice prior to issuing a demand. There is a 30 day deadline to file a dispute before a demand is automatically issued.

Once a demand is issued, the deadline to file an appeal is 120 days from the date the demand letter was received. There is a legal presumption under federal regulations that a demand was received within 5 days of when it was issued. CMS has been strict about enforcing appeal deadlines and will consistently dismiss appeals that are filed late.

If an appeal deadline has passed, unfortunately the options for challenging a demand are more limited. Courts have consistently held that parties must appropriately exhaust all administrative appeals in order to seek judicial review. However, there have been many cases in which we have been able to convince CMS to withdraw conditional payment claims when more than 125 days have passed since the demand was issued. The process can be much longer and more challenging, but federal regulations allow CMS to withdraw claims in certain circumstances.

If you have any questions or need assistance with a conditional payment claim dispute or appeal, please do not hesitate to contact us. We will be happy to help.