Challenging Unrelated Medical Expenses on Medicare Liens Part 1
Liens leaving you unsettled? Personal injury attorneys often find that Medicare liens are often an obstacle to their client’s personal injury settlement. Attorneys who have experience with personal injury liens understand that the work that goes into negotiating a lien is complicated. If your client’s lien amount is much larger than expected, read on to learn how you can challenge the amount. Read part two to learn more.
Shocked By a Larger Than Expected Payout to Medicare?
Medicare will place a personal injury lien against your client’s personal injury case for the treatment received following an accident; however, sometimes these seem a bit exaggerated to both you and your client.
This can become a complicated issue for a client who is already utilizing benefits for pre-existing medical conditions during the same time period in which the client is receiving treatment for medical issues related to their personal injury claim. It may appear that after factoring in medical expenses owed to Medicare, your client may not be receiving much of a settlement afterall. Presumably, this would lead your client to wonder why they even pursued a settlement in the first place.
Identifying Unrelated Expenses
The medical costs related to your client’s personal injury claim are reimbursable, and Medicare has every legal right to pursue recovery. Unrelated medical costs, however, are a different story. As your client’s advocate, it is critical that you examine your client’s Medicare expenses to differentiate the legitimate expenses from the unrelated expenses. From this point, Medicare should reduce the personal injury lien amount and your client should be entitled to a greater settlement amount.
The Conditional Payment Letter
The Medicare Secondary Payer Recovery Contractor (MSPRC) will send your client a “Rights and Responsibilities” letter as well a Conditional Payment Letter. The Conditional Payment Letter will show the lien amount and a payment summary with every injury-related payment made on behalf of your client’s injuries. Each expense will be coded with an Internal Control Number (ICN) code which provides details for each expense. While examining each entry, you will be able to identify which expenses are unrelated to the injury claim by reviewing the date of the claim and other pertinent information.
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Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.