You can download the pdf files and open them in Acrobat and then CTRL F search for the codes that show up on your conditional payment letters from Medicare. This will help you sort out medical visits that have been “coded” for payment for non-related medical procedures and visits.

This makes it easier to find and eliminate appointments for pre-existing conditions. You can also scan in a long conditional payment spread sheet, do a conversion to searchable text (OCR) and then use the search feature on that to find the billing codes.

Hope this is helpful to some of you.

Chris Nichols
www.NicholsTrialLaw.com

I was sent this brief “idiot’s guide” to dealing with Medicare and thought it was an excellent summary of the process. I’ve posted it in full, along with the contact information for a company that will help with the lien resolution process. I am not endorsing their product as I have never used their services.

http://lienblog.wordpress.com/2010/07/02/the-idiot%E2%80%99s-guide-to-medicare-lien-resolution/

The Idiot’s Guide to Medicare Lien Resolution

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.

Ryan J. WeinerCo-Founder Lien Resolution Services

www.lienresolutionusa.com
http://lienblog.wordpress.com
rweiner@lienresolutionusa.com

The Centers for Medicare & Medicaid Services will be implementing a new and simple fixed percentage option that will be available to certain beneficiaries beginning November 7, 2011. This option is available to beneficiaries who receive certain types of liability insurance (including self-insurance) settlements of $5000 or less.

A beneficiary who elects this option will be able to resolve Medicare’s recovery claim by paying Medicare 25% of his/her total liability insurance settlement instead of using the traditional recovery process. This means that a beneficiary will know what he/she owes and will be able to immediately pay Medicare.

In order to elect this option, the following criteria must be met:

1. The liability insurance (including self-insurance) settlement is for a physical trauma based injury. (This means that it does not relate to ingestion, exposure, or medical implant), and
2. The total liability settlement, judgment, award, or other payment is $5000 or less, and
3. The beneficiary elects the option within the required timeframe and Medicare has not issued a demand letter or other request for reimbursement related to the incident, and
4. The beneficiary has not received and does not expect to receive any other settlements, judgments, awards, or other payments related to the incident.

A full explanation, including instructions on how and when to elect this option, will be available on this website on November 7, 2011 in the Fixed Percentage Option section of both the Attorney and Beneficiary Toolkits.

Please Note: When a beneficiary elects this option, he/she must understand that as part of choosing the option he/she will be giving up the right to appeal the fixed payment amount or request a waiver of recovery for the fixed payment amount.

The article says that the Bush administration “will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals.”  The new rules go into effect in October, 2008

Charges can not be passed down to patients. The administrative rule stems from a 2006 law but the implementation was delayed for fear that hospitals would pass along the charges to patients.

Under the rules, the charges CAN NOT be passed along to the patient.

Common Errors and Infections. There is no indication exactly how the program will determine which fees are the results of preventable errors.  However, it does look like certain issues will be considered “per se” error, such as bed sores, bladder infections resulting from catheters, and preventable infections such as those stemming from staphylococcal infections.

The rule identifies eight conditions — including three serious types of preventable incidents sometimes called “never events” — that Medicare no longer will pay for. Those conditions are:

• Objects left in a patient during surgery
• Blood incompatibility
• Air embolism
• Falls
• Mediastinitis, which is an infection after heart surgery
• Urinary tract infections from using catheters
• Pressure ulcers, or bed sores
• Vascular infections from using catheters
• The Centers for Medicare and Medicaid Services said it also would work to add three more conditions to the list next year.

$20 Million Dollars Worth of Malpractice.  The Bush administration expects this will save $20 million per year, which to me means there is $20 million per year worth of treatments designed to “fix” malpractice.  You can count this as one of the first times this Administration has recognized the prevalence of medical negligence.

Implications for Attorneys.  The implementation of this policy only seems to have positive implications for victims of malpractice.  The most obvious would be that if Medicare does not pay for these services, then there can not be a lien from recovery.  I would suppose that if one gets a verdict or settlement on a malpractice claim that if Medicare has paid, the attorney for the patient could argue that Medicare should receive a refund from the medical provider rather than a lien against the Plaintiff’s recovery.  Right now I don’t know the effective date of the policy change.

I will be doing further research to see how the regulations will be implemented.  I’m assuming that Medicare’s refusal to pay for “malpractice” will not be admissible to prove negligence in malpractice cases.

A further question is what happens when the victim of malpractice needs medical treatment for the remainder of their lives?  Will the hospital be paying for all the bills?  I’m thinking this will be a difficult issue in some cases.

Check back for updates on this post.

Chris Nichols
www.NicholsTrialLaw.com