“Negotiating” With Medicare

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.

For help with Lien Resolution or Medicare disputes, contact a Lien Resolution company.

Ryan J. Weiner
Co-Founder Lien Resolution Services
This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.

About Ryan J. Weiner

Co-Founder of Lien Resolution Services, LLC, a national healthcare lien resolution firm. Our goal is to assist in the fair administration and resolution of healthcare liens on personal injury cases. Please visit our website for more information: www.lienresolutionusa.com.

12 comments on ““Negotiating” With Medicare

  1. […] Lien Resolution Services – Healthcare Lien Resolution Blog News and Analysis of the Latest in Subrogation « “Negotiating” With Medicare […]

  2. […] As a result, sometimes unrelated codes remain part of the lien.  You will have to write a lien dispute, or, as most attorneys attempt, negotiate with […]

  3. […] Audit the payment summary and ICD-9 codes listed.  This begins your Medicare “negotiation” process. […]

  4. […] costs or fee – because the MSPRC will not have that information.  Additionally, your Medicare negotiation ability will be limited.  Failure to respond will lead to a waiver of dispute privileges (but note […]

  5. […] a lien is too low is just as important as spending the hours to audit a lien, and then compiling a Medicare lien dispute.  It may take time, but lien resolution is a necessary […]

  6. […] is not satisfactory after step 5, you must dispute the ICD-9 codes via letter (this is the way you negotiate with Medicare).  The MSPRC will then send a new Conditional Payment Letter in approximately 45 […]

  7. […] What if Medicare’s Lien Exceeds Client Recovery What do you do if a Medicare lien exceeds your client’s recovery?  Obviously, if Medicare were to take 100% of proceeds from a settlement or verdict, plaintiffs would have no motivation to file lawsuits.  As a result, Medicare liens can be reduced through both automatic, and plaintiff-initiated processes.  But remember, Medicare does not truly negotiate (see “‘Negotiating’ With Medicare“). […]

  8. […] 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. […]

  9. […] it isn’t really negotiating, we nonetheless term it, Negotiating With Medicare.  The negotiation […]

  10. […] your clients’ cases LRS is here to help.  We dispute, appeal, compromise, and use any other Medicare lien negotiation tactics to successfully reduce your Medicare […]

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: