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When to Report to Medicare

Many attorneys ask when is the appropriate time to report a case to Medicare’s Coordination of Benefits Contractor (COBC).  I always answer the same way:  Yesterday.

Plaintiffs’ attorneys can be held responsible for non-payment of Medicare liens.  See U.S. v. Harris to educate yourself on some of the potential Medicare penalties.

This responsibility means that you should get started as soon as possible.  I understand that the Medicare lien resolution process can be difficult and time-consuming – but that does NOT absolve you of the responsibility you have under the Medicare Secondary Payer Act.

To report to Medicare:

  1. Call the COBC at 1-800-999-1118
  2. Establish a Medicare record based on COBC questions
  3. Send consent to the MSPRC
  4. Wait 15 days from your COBC call to receive a Rights and Responsibilities Letter and then 65 days to receive a Conditional Payment Letter

At this point, you have an initial lien amount – but that is not your final amount.  You should audit all ICD-9 codes listed in the Conditional Payment Letter to determine if they are related to the case.  More often than not, you can find unrelated codes.  If you don’t know what to do, contact a lien resolution assistance company.

Even if you have already settled your case, you MUST report to the COBC and then work with the MSPRC.  Completing this process, including the lien audit and requisite disputes, will save your client thousands of dollars.

Start early.  Get help.

Ryan J. Weiner
Co-Founder Lien Resolution Services

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.

One comment on “When to Report to Medicare

  1. […] Where settlement occurs prior to the issuance of a Conditional Payment Letter, or where settlement is reported concurrent with initial COBC reporting. […]

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