How to Resolve Medicare Conditional Payments

As a personal injury attorney, it is critical to know and understand the best way to resolve Medicare Conditional Payments. First, be prepared and plan a strategy to know approximately how much the lien will be as the case progresses. Second, communicate with your client so they understand that a lien may exist and that their settlement or judgment will be reduced because of the Medicare lien. Setting clear expectations for everyone involved is the key to a harmonious relationship and successful results.


Best Practices for Medicare Liens:  

  1. Recognize and report the case to Medicare. This must be done to the BCRC or the CRC depending on the case type.  
  2. Request a Conditional Payment Letter (CPL) from Medicare. This will list all payments that Medicare believes to be related to the lawsuit. Keep in mind that you must have authorization and provide it to Medicare.  
  3. Review the Medicare lien to determine if the code sections are related to the injury by date and relatedness to the actual injury. Dispute these charges and have them removed from the lien.  
  4. After you notify Medicare of the settlement, it will issue a final lien. Remember that the lien is not set in place (or locked) until Medicare provides its Final Demand.  
  5. Medicare must be paid within 60 days of it issuing the Demand. If the Medicare lien remains unpaid, then interest will accrue.  
  6. If the settlement amount has not been paid to your client, you can communicate with Medicare to avoid additional interest accruing. Proof will be required.  


Resolving Medicare’s Conditional Payment Letter is instrumental to the lien resolution process. Be sure to pay attention to its details in order to serve your client’s best interest.


If you have any questions about this process, come talk to us at the Michigan Association for Justice (MAJ) First Annual Summer Convention on June 7, in Grand Rapids, MI. MASSIVE’s Partners, Ryan Weiner, Esq. and Marcy Spitz, Esq. are presenting during the Liens Seminar and can answer your tough lien resolution questions.