I cannot remember one phone call where a potential customer (attorney) wants to know how to “negotiate” with Medicare. So, I have decided to explain the Medicare lien resolution process:
1. Report to Medicare’s Coordination of Benefits Contractor (“COBC”). Call 1-800-999-1118. You will need your client’s name, DOB, SSN, and the DOI. Sometimes the operator asks for the client’s address, HIC#/Medicare number, and liability insurer’s information.
2. The COBC will transfer the case to the Medicare Secondary Payer Recovery Contractor (“MSPRC”) in about 2-4 days. You will receive a “Rights and Responsibilities Letter” approximately 15 days later. Then, after 65 more days, you will receive your first Conditional Payment Letter (“CPL”).
3. Get consent. The MSPRC will not speak to you unless you have consent from your client. Form language is available at the MSPRC website, or you can learn about MSPRC consent language (under the Medicare/MSPRC Documents heading).
4. Medicare does not negotiate. The MSPRC accepts disputes, appeals, and waivers. The Centers for Medicare and Medicaid Services (“CMS”) accept Compromise requests. To utilize any of these methods for “negotiation” you will have to audit your Conditional Payment Letter for related and unrelated Medicare claims. Medicare uses the ICD-9 for its billing codes.
Then, you must prepare and send arguments as to why certain payments do not belong in the lien via letter or fax to the MSPRC. Their review takes approximately 45-65 days. The MSPRC will not explain its decisions to you. It will simply send a new Conditional Payment Letter. Continue this process as needed. Please see our post of March 4, 2010 for more information on Medicare Timeframes.
5. Then, report settlement to the MSPRC. You should include your costs, a cost itemization, and your fee amount. The MSPRC will send a final demand within 3-4 weeks. You cannot disburse any funds to the client until you have paid the Medicare lien. Appeals and waivers are available after the lien has been satisfied. Additionally, you may feel that you have overpaid the Medicare lien, or that Medicare claimed too large of a lien. Please see Marcy Spitz’s discussion of Medicare lien overpayment from March 30, 2010 for more information.
Co-Founder Lien Resolution Services www.lienresolutionusa.com https://lienblog.wordpress.com firstname.lastname@example.org