North Carolina Trial Law Blog

Typically, Medicare liens are placed on the personal injury case of a person whose treatment is paid by Medicare.  Medicare’s agents, the COBC, MSPRC, and CMS have a right to recover funds which would not have been paid without the negligent act which harmed the plaintiff-beneficiary.

If you are the Medicare beneficiary and plaintiff in a lawsuit, your attorney should handle the Medicare liens for you.  If you are the attorney, but you don’t know how to handle the lien, or just need some help, follow these simple steps:

1. Report the case to the COBC
   1. Call (800) 999-1118
   2. Be prepared to give the following Plaintiff/Beneficiary information:
      1. Name
      2. Social Security Number
      3. Medicare Number (a/k/a HIC Number)
      4. Date of Birth
      5. Address
      6. Date of Incident
      7. Injury (the COBC prefers physical body parts )
      8. Defense insurance (if known)
2. This should be the only time you deal with the COBC
3. Wait 10-15 days.  During this time period the COBC will transfer the file to the MSPRC, another Medicare agency.  At the end of this time period you should receive two (2) pieces of Medicare lien information from the MSPRC:
   1. First, you will receive a Beneficiary Information Questionnaire (you will recognize this document based on the red grid lines on the back pages).  This document can be ignored if, and only if, the plaintiff-beneficiary’s information has not changed.
   2. Concurrently, you will receive a Rights and Responsibilities Letter.  This will give some information on the Conditional Payment Letter process.  No action on your part is required.
      1. This Rights and Responsibilities Letter starts a countdown until you should receive a Conditional Payment Letter (a/k/a the initial lien).  That countdown will last 65 days – however, you need something else to receive the letter.
      2. Within the 65 day period, you need to send consent  and proof of representation to the MSPRC.  If you do not send the consent, you will not receive information on the Medicare lien, nor will you be able to speak to MSPRC representatives regarding your case.
         1. Unfortunately, the MSPRC is notoriously slow.  Without constant checks on the status and timeline, your Conditional Payment Letter probably won’t arrive within the 65 day period.
            1. Be sure to call the MSPRC to check the status of your consent (its validity).
            2. Be sure to call the MSPRC multiple times after to check the status of your Conditional Payment Letter.
            3. Please be ready to wait when you call theMSPRC.  Hold times range anywhere from 10 to 55 minutes (and increasing).  In fact, due to theMSPRC’s inability to handle current volumes of mail, its call center is now closed on Fridays.
4. After all that time and effort you should receive the Conditional Payment Letter.
   1. But if you did not bother to call the MSPRC – you probably don’t have it!
   2. You’ve received the Conditional Payment Letter, now what?
      1. Review the payments.  Check every ICD-9 code and injury to make certain they relate to the plaintiff’s sued-for injuries.
         1. Hint: ICD-9 Code 250.00 (Diabetes Mellitus) usually does not relate to malpractice or a personal injury.
5. On nearly every Conditional Payment Letter there will be unrelated codes – this means the lien is too high and Medicare is claiming funds to which it is not entitled.
6. If you have time before settlement you should Dispute theConditional Payment Letter.
   1. The MSPRC requires these in writing.
   2. Dispute the codes that are unrelated and explain why the MSPRCwas wrong to include them.
   3. Be detailed.
   4. The MSPRC will take 60-90 days to review your dispute.  When it replies to your dispute it will not give reasons, it simply sends a new Conditional Payment Letter.
   5. The case is settled, how do I pay Medicare?
      1. First you have to request a Final Lien Demand by notifying theMSPRC of settlement.
         1. Be sure to include the settlement, attorneys fee, any costs incurred (plus an itemization), and the date of settlement.
         2. In 30-45 days you will receive a Final Lien Demand.  This is the amount you must pay to Medicare from the settlement proceeds.
            1. You have 60 days to repay the lien before interest accrues.
            2. If you fail to pay within 60 days the interest will accrue for all 60 days plus any additional time.
7. A Final Lien Demand is not really final:
   1. You can appeal the Final Lien Demand on the basis that unrelated payments are included in the lien.
      1. You must do so within 120 days.
      2. Be very careful and detailed when appealing.  Keep in mind the MSPRC is the judge, jury, and executioner at this point of the Medicare lien appeal.
   2. Other methods exist to lower the lien, including:
      1. Compromises with CMS.
      2. Waivers through the Social Security Administration.
      3. Now that I appealed, how does my client get aMedicare Lien Reimbursement?
         1. Medicare lien reimbursements (for “overpayment”) take 10-14 weeks to be processed and sent to your client.
         2. You don’t have to do anything once the appeal has been agreed to by the MSPRC.
            1. But the check will go straight to the last-known address for the beneficiary.
            2. If you want the check to go to your office you must contact the MSPRC and request it be sent to you.
               1. Usually this check arrives as a two-party check.
               2. This will protect the interests of all heirs who have an entitlement to the lawsuit funds.
               3. Now you can put the check into your escrow account and disburse the funds as is legal, ethical, and agreed to by the plaintiff, heirs, and secondary lienholders.
8. Timelines:
   1. Reporting to COBC – Day 1
   2. COBC transfer to MSPRC – Day 3-5
   3. MSPRC sends Rights and Responsibilities letter, starting 65 day countdown to a Conditional Payment Summary, or Initial Medicare Lien – Day 15-20
   4. Conditional Payment Letter arrives – Day 80-85
   5. Disputes add 60-90 days
   6. Compromises add 60-90 days
   7. Appeals add 60-90 days
   8. Notice of settlement to receive Final Lien Demand
      1. Was 10-21 days
      2. Now is 30-45 days
      3. If you do everything right in Medicare Lien Resolution, you could resolve a lien within 110 days; but, if you let letters sit and do not take the time to carefully review and resolve your liens, they could take years.
         1. Report early;
         2. Call often; or,
         3. GET HELP!  Lien Resolution Servicesspecializes in this process.  When we see a Medicare letter, we know what to do with it – reducing lag time and speeding up the lien resolution process.  LRS makeslien resolution 100% of our focus; we take this administrative work off your hands providing you with time to practice law and litigate cases.
         4. Best of all – The cost of lien resolution isbillable to the client, just like an expert fee.  The attorney pays nothing; and, while the client pays a small fee, he or she ultimately benefits by a reduced lien, faster disbursement, and results.
         5. Contact us for all of the above.