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If you have any questions about your legal matters, contact Lien Resolution Services, LLC today.

1.  What obligations do parties have to report to Centers for Medicare and Medicaid Services (CMS) in a liability settlement?
Answer:  Attorneys for Plaintiff must report to the Coordination of Benefits Contractor (COBC) with information such as the Medicare number, injury, date of injury/loss, and other pertinent information.  Later, they must submit consent forms and proof of representation to the Medicare Secondary Payer Recovery Contractor (MSPRC).  Then they should address any unrelated payments and dispute those payments. Finally, a settlement should be immediately reported to Medicare's MSPRC.

2.  What are my responsibilities as the plaintiff's attorney in a pending claim situation?
Answer:

  1. You must report the case to the COBC
  2. You must report settlement to the MSPRC
  3. You must pay the final amount of the lien after the resolution process has been completed

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3.  What happens if an attorney fails to make the appropriate payment to the government for the cost of the lien?
Answer:  If Medicare is forced to initiate litigation to recover its conditional payments, the primary plan insurer and beneficiaries could be liable for up to double the amount of the conditional payments (see U.S. v Harris, N.D. W.Va., 2009).  The attorney also has direct liability for reimbursement if Medicare’s lien is not fully satisfied.  In fact, Medicare's agencies may seek double damages and interest against the attorney.  Furthermore, failure to pay may cost the client his or her Medicare coverage and Social Security may offset benefits until a Medicare claim, and its interest, is satisfied.

4.  Why do the Centers for Medicare and Medicaid Services (CMS) call their medical payment itemizations a Conditional Payment Letter?
Answer:  Medicare only pays for treatment on a conditional basis, with the expectation for reimbursement.  Medicare is statutorily the secondary payer, and is responsible only for paying amounts not covered by the primary insurance plan.

5.  How can you determine what charges may or may not be related to the pertinent injury in the lawsuit?
Answer:  You must review the medical history of the client and compare that to the code sections used in the Conditional Payment Letter.  Additionally, you should review the dates of the charges to see when the charges were made and by what entity.  All of these factors affect the relatedness of Medicare payments to the lawsuit.

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6.  Does CMS make mistakes on Conditional Payment Letters?
Answer:  Yes – all of the time.  Sometimes these mistakes add up to thousands, or hundreds of thousands of dollars, so if you fail to submit an appeal or compromise in response to the Conditional Payment Letter, the client could end up with very little, or even no recovery, after the lien, costs, and attorney fees are paid.  This kind of scenario does not bode well for your firm as your client stands to lose some or all of its settlement money to the government – while you still get your money.

7.  Do the various government offices make changes to their internal practices without notifying the lien community?
Answer:  Yes.  Medicare's contractors continue to change policies so that one day a submission may be proper, but the next day it could be rejected without notice.  These offices (COBC, MSPRC, CMS) sometimes fail to send notices of missing documents to your attention.  This oversight can cause undue delays to the processing of a lien.  Some attorneys have experienced incidents where the MSPRC has lost an entire file after it had been initiated, leading to months delay in the distribution of funds to a client.  Constant attention to a lien file is the only way to avoid these delays.

8.  What happens when a client fails to pay the final lien demand after settlement information has been furnished to Medicare?
Answer:  Interest begins to accrue at a rate above ten percent per annum after the due date.  Beyond that the case gets referred to the Treasury department for further collection efforts.  If that is not successful there are private debt collectors assigned to the case.  During this time interest is accruing and your client is losing money that could have been in their possession if the lien had been resolved timely.  The attorney may be liable for a client’s nonpayment; it is illegal to disburse funds prior to reimbursing Medicare.

9.  What is the easiest way to resolve a Medicare lien?
Answer:  Lien Resolution Services, or another firm specializing in healthcare reimbursement matters, should be contacted to resolve any medical liens.

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