If you have a personal injury claim and receive Medicare or Medicaid benefits, you have certain legal obligations to Medicare that will affect your claim. If you have a personal injury lawyer representing you, your attorney should handle this challenging process for you. Any settlement or verdict you receive will likely be reduced by a portion of any amount Medicare paid for your medical treatment that relates to your personal injury claim. An attorney skilled at handling Medicare liens can help insure that Medicare doesn’t take more money from your settlement than is necessary.
For many lawyers who are inexperienced with handling Medicare liens, this process can be a nightmare. However, if they follow the simple step by step approach that West Law Offices uses to resolve its client’s Medicare liens, the process will be less daunting.
1. Determine if client is receiving Medicare/SSDI or Medicaid/SSI.
- Ask client if receiving medicare/SSDI or Medicade/SSI.
- Send letter to local social security office asking if client receives social security benefits. Include with letter Social Security Consent release form.
2. Duty to Inform – if client is receiving Medicare or Medicade, report his or her claim to Coordination of Benefits Contractor Center (COBC) at 800-999-1118.
3. COBC automatically transfers the case to the Medicare Secondary Payer Recovery Center (MSPRC). Direct all future correspondence (by fax) to MSPRC: MSPRC Liability, PO Box 138832, Oklahoma City, OK 73113. 1.866.677.7220 phone and 1.405.869.3309 fax.
4. Send a Representation Packet to MSPRC. In the Packet include the following:
- A cover letter on West Law Offices letterhead requesting a copy of the “Conditional Payment Summaries.” Expect a response in 65-90 days.
- In the cover letter, also detail the client’s injuries that are directly related to the lawsuit and include the date such injuries occurred.
- Attach a signed HIPAA consent.
- Attach Proof of Representation: a signed Attorney Client Agreement with the client’s name and Medicare Health Insurance Claim Number (the number on the client’s Medicare card) written at the top of the first page.
5. Within seven days of sending Representation Packet, call MSPRC to make sure COBC has transferred to its offices and has begun the process of determining what bills have been paid by Medicare that may be related to the personal injury client’s lawsuit.
6. At 30 days call MSPRC to check the status of file.
7. Once MSPRC sends a conditional payment summary, audit it as follows:
- Review ICD-9 codes
- Circle unrelated payments
- Provide documentation that payments are unrelated
- Identify grouped ICD-9 codes
- Identify exacerbated injuries
- Provide medical records.
8. Send MSPRC petition to adjust its conditional payment summary and follow up within 7 days to make sure it has been received and is being processed.
9. WAIT FOR SETTLEMENT OF LAWSUIT OR VERDICT
10. After settlement or verdict, request updated Conditional Payment Summary – Review & Audit it the same as first Conditional Payment Summary.
11. Submit final settlement form to MSPRC.
12. Once settlement of the client’s personal injury lawsuit has been reached and the final settlement form has been submitted to MSPRC, the “final demand” process begins.
13. Medicare will then issue a final demand letter, and payment in full must be made to Medicare within 60 days.
If you have been injured because of negligence, it’s advisable to consult with a skilled personal injury attorney. If you receive Medicare or Medicaid benefits, it is even more important to speak with an attorney. West Law Offices offers those injured injured West Virginia free consultations with a personal injury attorney. Additionally, we never charge a fee until we win your case. Call toll free 1-877-943-9378 to speak with a lawyer.