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CMS User Guide 3.1 Released

CMS has released User Guide 3.1 for MMSEA reporting.  You can find a copy of the user guide on the Lien Resolution Services website, or, by clicking here.

While most changes involve Responsible Reporting Entity (“RRE”) requirements, some of those changes will have a trickle down effect on plaintiffs, their Medicare liens, and plaintiffs’ attorneys.  For example, on page six of the User Guide it states,

The requirements for reporting ICD-9 diagnosis codes in Section 11.2.5 were updated to clarify that ICD-9 diagnosis codes submitted should be those that reflect the illnesses/injuries claimed and/or released by the settlement, judgment, award, or for which ORM is assumed.

This language is somewhat concerning.  Consider that most complaints will list every body part as a potential injury.  At the same time, most settlements are limited in language discussing the injuries.  So what happens when the RRE reports everything in the complaint, yet the case was really regarding just one, limited injury?  Obviously, lien resolution gets more difficult.

At LRS, we suggest two steps to protect your clients from excessive Medicare liens.

First, report the case on your own, prior to the RRE reporting and as soon as possible.  We recommend reporting the day you file a case.  You should do so even earlier if you suspect a pre-suit settlement.  This allows you to inform Medicare of its lien on your own terms.  The Medicare lien will then be based on the injuries you report.

Second, work with the defense attorney.  As plaintiff’s attorney, you can give the defense ICD-9 codes in advance so that their client, the insurance company and thus the RRE includes only those relevant codes.  Additionally, you can include the relevant ICD-9 codes in the settlement release.

These ideas are simply suggestions based on theory.  No one is sure how Medicare will react to the influx of information it will receive beginning January 1, 2011.  If Medicare does claim excessive liens on 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 liens.

Contact us for assistance.

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.

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