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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“).

Option 1:  Dispute the lien amount.  If you choose to dispute a lien you must do so prior to settlement.  This process involves writing a letter to the MSPRC requesting that it remove various charges and ICD-9 codes.  It can be as fast as 45 days, or as slow as 90 days (regardless of what the MSPRC quotes for timeframe).  You can write as many Medicare lien disputes as you choose.

Option 2:  Automatic procurement upon settlement.  The MSPRC will reduce a lien by the percentage that your costs/fee were of the settlement.  So, if you have $10,000 in costs on a $100,000 settlement, and you take a $30,000 fee, the Conditional Payment Letter amount will be reduced by 40% for the Final Lien Demand.

Option 3:  Appeal following settlement.  The appeal process must be initiated within 120 days of issuance of the Final Demand.  It can include various methods, including letters similar to the Medicare lien dispute.  The expected timeframe for an MSPRC decision should be 60-120 days (lately toward 120 days).

Option 4:  Social Security Administration Financial Waiver.  This process is only successful for those in financial disarray.  Due to the recent economic troubles, perhaps more plaintiffs apply than in the past; however, very few financial waivers are actually accepted.

The above-noted options are the most commonly used, additional, more complex methods may be utilized in some circumstances.  After you successfully reduce a Medicare lien, your client may be entitled to reimbursement.  Please see Marcy Spitz’s excellent argue on the concerns and processes of Medicare Reimbursement.

If you have any questions or require assistance on Medicare liens, Medicaid liens, or any other healthcare lien, please contact us.

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.

One comment on “What if Medicare’s Lien Exceeds Client Recovery

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