When you write a Medicare lien dispute it’s important to know where the MSPRC gets its information. It’s just as important to know that there really isn’t a way to perform a Medicare lien negotiation.
So just how does Medicare get it’s information about your cases?
Before Section 111 & MMSEA Implementation
First, the plaintiff’s attorney reports the case to the COBC with a basic description of the injury. Then, during the lien resolution process, that same attorney will give additional information via phone calls or letters while attempting to resolve the lien.
Second, the MSPRC is able to review all billing codes when compiling the lien. Its agents can utilize these codes to build a picture of each hospitalization. Unfortunately, these codes rarely tell the entire story. That is why you need to be precise in your lien resolution methods.
After Section 111 & MMSEA Implementation: The 50 Data Points
For all cases settled or closed after October 1, 2010, RREs will report certain information to the MSPRC. This information has become known as the 50 Data Points (even though it can extend to more than 100).
These data points will fit under umbrella groups, including:
- Injured party/Beneficiary data;
- Primary plan (defense) data;
- Injured party/Beneficiary’s attorney data;
- Incident data; and
- Settlement data.
The fourth group, “incident data,” will become extremely important to closing a case and distributing funds. Plaintiff’s attorneys will need someone in their office to communicate with the defense attorneys to make sure that the appropriate ICD-9 codes are reported as incident data. Otherwise the MMSEA could cause headaches and settlement delays.
Co-Founder Lien Resolution Services www.lienresolutionusa.com https://lienblog.wordpress.com firstname.lastname@example.org