What criteria do you look for in cases you assist in resolving?
We have designed our systems to help you to avoid spending the time to pick which cases to send us. We look for any case that has, or might have, a lien to resolve. We are able to provide verification of certain health insurance coverage in addition to lien resolution. We will handle any case, from single lien cases to those that are upside down with major liens. Our proprietary workflows reduce time-consuming delays in all circumstances while our fee structure allows you to send all cases.
Do you speed the normal process up?
Yes. Our 87-step workflow holds Medicare to their quoted time frames, helping to avoid all unnecessary delays in the settlement, negotiation and disbursement processes. Through efficient and meticulous strategy, we have been able to bridge the Medicare gap, making the process less daunting and time consuming for you and your client.
We do the same for Private Health Insurance liens, ERISA liens, Medicaid liens, and any other health insurance liens.
What is the cost and how is it applied?
At Med Lien Solutions’ we have designed fee structures to fit all sizes of law firms and cases. We have both progressive fees based on lien size and success-based fee structures available to fit your firm.
Med Lien Solutions’ charges for lien resolution services are based mostly on our performance, which is tied to the amount we are able to reduce all liens, including the Medicare “Super Lien.” For firms that choose our success-based fee structure, our fee is based on the amount we save your client. We are paid for performance. As a result, our fee increases only if we can help your clients.
Most important with all of our fee structures is that you pay us nothing up front and there is no fee if your case is not successful. Contact us today to see how we can valuably reduce and resolve your client’s liens.
Do Medicare and other lien holders recognize Med Lien Solutions, LLC as an authorized third party?
Yes. While most correspondence occurs between Med Lien Solutions, LLC and the BCRC, all of Medicare’s agents recognize Med Lien Solutions, LLC as the third party representing the law firm and plaintiff’s interest. Similarly, other lien holders recognize Med Lien Solutions, LLC as an authorized representative of the plaintiff because we always utilize proper authorization and proof of representation procedures.
How long is the Medicare lien resolution process?
Our Medicare lien resolution processes limit the lien resolution process to between 3 months and 5 months for the average case. Some cases requiring appeals may take longer. The best way to make Medicare lien resolution faster is begin the process early. We believe that any case we have started should be ready for disbursement within 35 days of settlement.
I’m not sure if my client has Medicare – is there a way to check Medicare eligibility?
Yes. We can perform formal and informal eligibility checks to determine if your client is a Medicare beneficiary.
Why do the Centers for Medicare and Medicaid Services (CMS) call their medical payment itemizations a Conditional Payment Letter?
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 (the defendant’s insurance).
Does CMS, the BCRC, or any other lien holder make mistakes on Conditional Payment Letters or liens?
Yes – all of the time. Sometimes these mistakes add up to thousands, or hundreds of thousands of dollars. If you fail to submit a dispute or appeal 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. At Med Lien Solutions we are able to identify and remove these mistakes through our OCR software and our staff attorneys’ detailed lien reviews.
How can you determine what charges may or may not be related to the pertinent injury in the lawsuit?
We review the medical history of the client and compare that to the ICD-9 code sections used in the Medicare Conditional Payment Letter or other lien holder’s itemization. Additionally, Med Lien Solutions’ proprietary Optical Character Recognition (OCR) software reviews all liens within seven seconds to determine whether the payments are related to the case. If they are not related, we dispute them, resulting in a greater net recovery for your client.
Do the various government offices, CMS, BCRC, or private lien holders make changes to their internal practices without notifying the lien community?
Yes – this problem is especially prevalent with Medicare, whose contractors continue to change policies so that while a submission may be proper one day, the next day it could be rejected without notice. These offices sometimes fail to send notices of missing documents to your attention. This oversight can cause undue delays to the processing of a lien, leading to months of delays in the distribution of funds to a client. Our 87-step workflows provide constant attention to a lien file to avoid these delays.
What is a Medicare “Super Lien”?
Congress passed the Medicare Secondary Payer Act (“MSP”) in 1980 as a cost-recovery measure designed to prevent Medicare from paying for medical care that should be paid by other insurance. In the case of personal injury lawsuits, this other insurance refers to the defendant’s liability insurance and not another medical insurance. This act makes Medicare “secondary” and the other insurance “primary.” Medicare will not pay for any medical care where “payment has been made, or can reasonably be expected to be made” by primary plan. 42 U.S.C. §1395(b)(2)(A). This means Medicare will not pay where the care resulted from another person’s negligence and a lawsuit exists.
Medicare’s “Super Lien” arises where a primary plan is responsible for the payments, and Medicare makes conditional payments. These conditional payments are made where “a primary plan … has not made or cannot reasonably be expected to make payment with respect to such item or service promptly.”
Why is Medicare’s “Super Lien” so strong?
Medicare’s “Super Lien” is so strong because the statute states, “the United States may bring an action against any or all entities that are or were required or responsible … to make payment with respect to the same item or service … under a primary plan.” 42 U.S.C. §1395(b)(2)(B)(iii). Then, the statute also states the U.S. “shall be subrogated … to any right under this subsection of an individual or any other entity to payment with respect to such item or service under a primary plan.” 42 U.S.C. §1395(b)(2)(B)(iv). Next, the MSP and the 2003 Medicare Modernization Act reinforce the “Super Lien” status by creating an affirmative duty for all those involved in the lawsuit to notify Medicare of the lawsuit and satisfy the lien. That duty is clearly and powerfully stated in 42 U.S.C. §1395(b)(2)(B)(ii), stating all parties to the lawsuit and their counsel, “shall reimburse [Medicare] for any payment … if it is demonstrated that such primary plan has or had a responsibility to make payment with respect to such item or service.” This section of the United States Code and its ignorance of other liens, payees, and parties owed money as a result of the lawsuit, shows that Medicare comes first. As a result, Medicare’s “lien” is the “Super Lien.”
What obligations do parties have to report to Centers for Medicare and Medicaid Services (CMS) in a liability settlement?
Representatives for the Plaintiff must report to the Benefits Coordination and Recovery Contractor (BCRC) with information such as the Medicare number, injury, date of injury/loss, and other pertinent information. Later, they must submit certain authorization and proof of representation forms to the BCRC. Finally, a settlement should be immediately reported to Medicare’s BCRC. These duties arise out of 42 U.S.C. §1395(b)(2)(B)(ii), which states all parties to the lawsuit and their counsel, “shall reimburse [Medicare] for any payment … if it is demonstrated that such primary plan has or had a responsibility to make payment with respect to such item or service.”
What are my responsibilities as the plaintiff’s attorney in a pending claim situation?
You, or an authorized representative like Med Lien Solutions, must report the case to the BCRC. You must report settlement to the BCRC. And finally, you must pay the Final Demand after the resolution process has been completed.
I want to settle the case – how do I know Medicare’s Final Lien?
Unfortunately, you cannot determine Medicare’s Final Lien until after settlement. To combat this issue, President Obama signed the SMART Act on January 10, 2013. Beginning in 2016, the SMART Act will create a “Final Conditional” lien process that can be requested through correspondence with the BCRC.
For now – the best method to determine Medicare’s lien is to start the lien resolution process early in the litigation process. You, or an authorized representative like Med Lien Solutions, should continuously update Medicare’s lien for months, or even years. When the case is ready to settle you should have a stable lien amount that Medicare has reviewed multiple times. This constant updating should minimize surprise.
Do I need Medicare approval to settle my case?
No. Medicare’s right is that of reimbursement. It does not have control over your case.
My client needs all of the settlement money, will Medicare waive its lien?
If your client is in dire financial circumstances a Financial Hardship Waiver might succeed. Keep in mind our use of the word “dire.” Waivers are not often granted. You will need the Social Security Administration’s Form 632-BK.
Medicare’s demand is larger than the net settlement. Can they take all of my client’s money?
42 CFR 411.37 states that if the Medicare claim exceeds net settlement then Medicare’s Final Demand is equal to the net settlement. MLS is able to avoid this scenario and always provide some recovery for your plaintiff.
Can you reduce ERISA liens too?
Yes. Our team of specialists and attorneys includes a former Department of Labor attorney who worked specifically with ERISA plans in Washington D.C. Our team is able to work with and around the ERISA plans that can cause you so many delays in settlement.
My case involves a No-Fault or Med-Pay component – what special rules does Medicare have for the case?
Where your case includes a No-Fault or Med-Pay component Medicare opens two types of files. First, it opens the No-Fault file, which refers to continuing payments made by an insurance company. Second, it opens the Liability file, which refers to any lump-sum payment (settlement, judgment, etc.) regardless of whether it is from 1st party or 3rd party insurance. In order to obtain a Final Demand in the Liability case you must first get Medicare to close the No-Fault file. The easiest way to close the No-Fault file is by providing a letter from the insurer stating the benefits are exhausted. The two files will have different 15-digit Case ID numbers.
My case involves a wrongful death component, can I use that to my advantage in reducing the liens?
There is some case law that states Medicare is not entitled to wrongful death funds; however, Medicare will not quietly agree to such an allocation. More important, Benson v. Sebelius seems to state that you must never claim medical bills if you want the entire case to be qualified as wrongful death proceeds, and, Taransky v. Sec. of Health and Human Serv. takes that case a step further. It states that you must never release medical bills either.
My client will need future care, do I have to create a Medicare Set-Aside (MSA)?
If Medicare is forced to initiate litigation to recover its conditional payments, the attorneys, the defense (the primary plan insurer), and even Medicare 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.
Failure to pay a Medicare lien may cost the client his or her Medicare coverage and the Social Security Administration may offset benefits until a Medicare claim, and its interest, is satisfied. Med Lien Solutions reduces your firm’s liability by advising firms on what to pay, to whom, within all deadlines.
What happens when a plaintiff fails to pay the final lien demand after settlement information has been furnished to Medicare?
Failure to pay a lien will lead to the accrual of interest at a rate above ten percent per annum. The case will eventually be referred to the U.S. Department of Treasury for further collection efforts. If that collection effort is not successful the lien may be further referred to private debt collectors. 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.
The defense will not pay until I handle the Medicare lien, or, the defense claims they must pay Medicare directly – what do I do?
This has been a debated issue since the Medicare, Medicaid, and SCHIP Extension Act was signed by President Bush in 2007. We suggest a two check system.
Med Lien Solutions and the team of lien resolution experts can guide you through every scenario with transparency. We remove law firm liability, allowing you to focus on your core business. Call us today with any further questions you may have at 877-95-3641. We would be happy to speak with you about your lien resolution needs.