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Medicare & No-Fault: Speed Up the Process

If you practice personal injury, especially automobile accident law, you will run into extra steps for Medicare liens.  Medicare has long required information regarding any kind of No-Fault insurance before it compiles a Final Demand for your case’s lien.  Even if you’re not in a No-Fault insurance state you need to keep reading.  Why?  As with most things Medicare, “No-Fault” doesn’t just mean No-Fault.  It really means any kind of first party insurance, such as:

  1. No-Fault Automobile Insurance (including Michigan, New Jersey, New York, Florida, Pennsylvania, and others);
  2. Med-Pay; and,
  3. Personal Injury Protection (PIP).

Your time frame for Conditional Payment Letters (a/k/a initial liens) remains the same:

  • Day 0 – Report to COBC at (800) 999-1118;
  • Day 7-10 – Receive the COBC/CMS Red Grid data letter (which you can usually ignore);
  • Day 15-20 – Receive the Rights & Responsibilities letter;
  • Day 80-85 (or 65 days after the Rights & Responsibilities letter – Conditional Payment Letter is due.  Keep in mind you almost never receive it on time.  It will take some extra work to get the Conditional Payment Letter, but we usually are able to get it within 3-4 weeks of this due date.

Once you settle and notify the MSPRC of settlement a Final Demand is due in 35 days.  Not surprisingly, the MSPRC rarely gets the Final Demand to you within that timeframe.  Generally you can get it within 3-4 weeks with extra work.  Finally we get to the point where No-Fault comes into play.  The MSPRC will not issue a Final Demand until it knows the full value of your case.  You can try reporting each and every payment made to your client, from PIP and Med-Pay to Collision or Body Shop payments, but the MSPRC will not issue the Final Demand without the following:

  1. No-Fault/PIP/Med-Pay policy limits;
  2. A payment ledger for that policy; and,
  3. The last date of treatment for the plaintiff.

If you wait for the MSPRC to tell you they need this info, you’re probably waiting two months from the date you notify it of settlement.  If that doesn’t sound so bad, remember that the insurance company will get the same letter at the same time.  By the time it has sorted the letter and directed it to the correct adjuster, another 2-3 weeks has passed.  At that point, does the adjuster know what to do with that letter?  If he does, that’s great.  If he doesn’t, how much longer will this process take?

Assuming the adjuster knows what to print and where to send it, you can expect a Final Demand due date of 35 days from the date the MSPRC receives the payment ledger and policy limits from the insurance company.  You should remember that the mail will take 3 days and the MSPRC intake system (scanners) will take another 4 days.  Next, this is the MSPRC – their deadlines seem to be more guideline than time limit.  Add an extra 3-4 weeks.

So how long did it take you to receive a Final Demand?  How long have you been holding your client’s money in escrow?  My best guess is 4.5-5.5 months, 18-22 weeks, 126-154 days.

You can avoid part of this problem with the usual plan of preparation.  If you know Medicare is involved and you know some sort of “No-Fault” is involved, prepare all of what Medicare will request in advance.   This is easiest when the No-Fault has closed, been exhausted, or the plaintiff has been cut off from it.  If you can’t get the payment ledger you should at least explain to the adjuster/defense attorney how it will help speed up the case.  Most defense attorneys and insurance companies are afraid of Medicare’s MMSEA and Mandatory Insurer Reporting.  They will be eager to cooperate.

Likewise, if you are the defense, be prepared to send the policy limits, payment ledgers, and last date of treatment to the MSPRC.  Your initiative will speed up the process and show that you have indeed protected Medicare’s interests.

Dealing with Medicare always comes back to two things: (1) Preparation; and, (2) Dedication (to continuous follow-ups with the MSPRC of course).  If you need assistance with Medicare liens, Medicaid liens, ERISA liens, or any other healthcare liens, contact LRS.

Ryan J. Weiner
Co-Founder Lien Resolution Services
This Blog/Web Siteis 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 “Medicare & No-Fault: Speed Up the Process

  1. up vegas in…

    […]Medicare & No-Fault: Speed Up the Process « Lien Resolution Services – Healthcare Lien Resolution Blog[…]…

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