CMS Will Maintain $750 Recovery Threshold for 2023

The Centers for Medicare & Medicaid Services (CMS) is required to publish an annual threshold for recovery each year.  This threshold amount reflects an amount for which CMS will not spend more on collections than a claim is likely to yield. On December 13, CMS also announced that the recovery threshold for all non-group health plans will remain at $750 for 2023, which means that settlements of $750 or less do not need to be reported and Medicare’s conditional payment amount related to these cases does not need to be repaid.

CMS reviewed the costs related to collecting data and determining the amount of Medicare’s recovery claim, as well as the available data (between August 2021 and July 2022) related to no-fault insurance and workers’ compensation settlements and made the decision to maintain the $750 threshold.

CMS also estimated cost of collection per NGHP case of approximately $306 to the average liability insurance demand amount per settlement range, based upon the amount of invoices paid to the Benefits Coordination and Recovery Contractors. CMS then did a comparison of the estimated cost of collection to the average no-fault insurance and workers’ compensation demand amounts per settlement range to arrive at the determination to maintain the threshold amount.

Links to the alert and the threshold methodology (as described above) are posted on the Non-Group Health Plan Recovery page of cms.gov.