Procurement Formula
SMART Act: Final/Conditional Medicare Lien Process
Looking back at yesterday’s SMART Act post it is hard to decipher how to properly obtain what we are calling a “Final Conditional” Amount or Lien. We hope the following workflow (including our assumptions and expectations of the future process) will help: T-120 days to settlement – Send an Expected Settlement Notice to the MSPRC; […]
ERISA, ERISA, ERISA!
In lien resolution (or subrogation, or reimbursement) ERISA means nothing. Let’s get that out of the way. Health plans can scream “ERISA!” at the top of their lungs. It still means nothing. One of 0ur younger attorneys at Lien Resolution Services dealt with this very issue last week. I like the way this ERISA lien […]
Medicare Advantage Plan Liens & Reimbursement
Medicare Advantage Plans often claim liens and/or reimbursement rights on personal injury lawsuits. This post isn’t about Medicare Advantage (“MA”) plan reimbursement rights (or whether the Medicare Secondary Payer statute allows federal actions for MA plans). Instead, this post aims to assist in reduction of MA plan liens. Last week, we were offered a 25% […]
Medicare Case Type Definitions: Liability & No-Fault
The most important part of Medicare lien resolution occurs months (or even years) before you send payment to the MSPRC. That most important process is reporting to the Coordination of Benefits Contractor (“COBC”). If you report the wrong date of incident you risk wasting months of work. If you report the wrong injuries you risk […]
Medicare Conditional Payment Notices
Yesterday I saw more Conditional Payment Notices from Medicare in one day, than I had the entire month of April. Conditional Payment Notices (“CPNs”) are different than Conditional Payment Letters (“CPLs”), but they should not concern you if you know how to respond. This post will discuss what is a CPN, what do to with […]
MSPRC to Offer Pre-Settlement Final Demands
The MSPRC recently announced a new option which essentially creates pre-settlement Final Demands for Medicare Liens. From its website: New Option to Self-Calculate Your Conditional Payment Amount On February 21, 2012, the Centers for Medicare & Medicaid Services (CMS) will implement an option that allows certain Medicare beneficiaries to self-calculate Medicare’s final conditional payment amount […]
Medicare Regional Coordinator Sally Stalcup at TTLA Convention
Sally Stalcup – MSP Regional Coordinator, CMS Dallas Region – spoke for half an hour at the TTLA Annual Convention in Austin, Texas on June 1, 2011. Some highlights include: She prefaced the talk with a statement that she cannot comment on recent cases/litigation. Perhaps she referencing Haro v. Sebelius. On Medicare Set-Asides (MSAs) MSAs […]
The MSPRC’s New Use of Conditional Payment Notices
Medicare’s MSPRC began sending Conditional Payment Notices (“CPNs”) last year. At that time, MSPRC representatives explained the use CPN in Town Hall Meetings. That use has seemingly changed. What is a CPN? It is notice given by the MSPRC that: It is aware you have settled; It may not know the settlement amount, fees, and […]
Bradley v. Sebelius: Medicare Not Entitled
On September 29, 2010, the 11th Circuit Federal Court ruled that Medicare is not entitled to the proceeds of a wrongful death settlement paid to the surviving children of a Medicare recipient. This news is a welcome addition to the personal injury world, where Tort reform has put caps on many death case recoveries. Could […]
MMSEA – RRE Reporting Begins Oct. 1, 2010
President George W. Bush signed the Medicare Medicaid & SCHIP Extension Act (“MMSEA”) more than three years ago. On October 1st, 2010, its reporting section finally goes into effect. How will reporting change the Healthcare Lien landscape? How will it change Personal Injury Law? The Defense Fears The MMSEA turns defendant-insurers into Responsible Reporting Entities […]
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