Are you Resolving the Right Medicare Lien?
There can be multiple Medicare liens for one personal injury event. Let that sink in.
We can acknowledge Medicare lien resolution is difficult enough, but how can there be multiple Medicare liens for one personal injury case? The Centers for Medicare and Medicaid Services (CMS) has created a complex system where different “debtors” look at different Medicare lien files. On top of that, a debtor may not necessarily exist – in Medicare’s eyes – until a certain event like settlement happens.
For example, in a motor vehicle accident case (with Med-Pay or PIP) there are three types of Medicare files:
- Medicare No-Fault (via the Commercial Repayment Center, or “CRC”): This file is designed to recover directly from the Med-Pay or PIP insurance carrier. A plaintiff can get information on the Medicare lien, but that’s it. It is up to the defense/carrier to ask Medicare to close this file when benefits are exhausted via policy limits or settlement that waives future benefits. While not relevant to the example, a Medicare Workers’ Comp file functions in a nearly identical way as well.
- Medicare No-Fault (via the Benefits Coordination and Recovery Contractor, or “BCRC”): This file is designed to recover from the injured person’s PIP or Med-Pay settlement – and only when a settlement occurs where the plaintiff or his counsel receives settlement funds. In fact, Medicare will often automatically close a No-Fault file at the BCRC if one currently exists at the CRC, and, if no settlement has occurred yet. It is the plaintiff’s responsibility to have BCRC open this file, and then pay BCRC’s Medicare Lien Demand.
- Medicare Liability (via the BCRC only): This file can be opened immediately by the injured person and her counsel. It is designed to recover from the plaintiff’s third-party-type settlement (Bodily Injury, Uninsured Motorist, Underinsured Motorist, etc. in a motor vehicle accident example; or, regular liability settlement otherwise). It is the plaintiff’s responsibility to have BCRC open this file, and then pay BCRC’s Medicare Lien Demand.
Plaintiffs and personal injury attorneys should be aware that the preceding Medicare files can all exist at the same time. If settlements are reported differently by the defense/carrier, you can expect additional files to be opened, as Medicare will not recognize even one-day differences between settlements. It will simply assume they’re additional settlements.
If you need assistances with any number of Medicare files please contact MASSIVE. We’re happy to help untangle the lien resolution web. We’re here to help whether it is a Medicare lien, Medicaid lien, ERISA lien, or any other type of health insurance lien.
MASSIVE’s Chief Operating Officer, Ryan Weiner, will be co-presenting on Resolving Conditional Payments in Liability, No-Fault, and Workers’ Compensation Claims at the Medicare Secondary Payer Compliance for Beneficiaries Conference on March 23.