Medicare Lien “Mail Bag”
MASSIVE’s Ryan Weiner, Esq. spoke at Rise’s 5th Annual Medicare Secondary Payer Conditional Payment Forum on July 28th. We received some great questions during that presentation, and we wanted to use them to help everyone learn more about the Medicare lien resolution process.
Question: Do you report Wrongful Death as a date of injury or a claim? For example, if a person falls and fractures their hip on 1/1/21 but dies on 2/1/21, do you report both dates of injury? The defendant always wants to report the date of incident, which is fine, but what about the heirs’ wrongful death claim that does not accrue until the date of death?
Answer: Wrongful death has specific rules defined by a line of Medicare cases ending with Taransky v. Sec’y of U.S. Dep’t of Health & Hum. Servs., 760 F.3d 307 (3d Cir. 2014). It is important to be aware those cases tell us that Medicare can collect from a wrongful death case if medicals were claimed at any point.
Regarding the DOI question: The defense carrier will be required to report the earlier date. If you’re a plaintiff, you want to report 1/1/21 (the earlier date) because not doing so will mean that the defense reporting of that date will cause Medicare to open a 2nd file.
Question: If a case was opened with the BCRC pre-settlement, and then a settlement was never actually reached (either claim dismissed or zero verdict), what happens if the BCRC is never contacted to close the case that was opened? There is no TPOC to report.
Answer: First, TPOC means Total Payment Obligation to Claimant. It is a Mandatory Insurer Reporting term used by Medicare and defense to signify the gross amount of settlement going to the plaintiff. In this case, both parties should contact Medicare notifying it that no settlement has been reached and no settlement will be reached. Ask Medicare to close the file. Technically Medicare can’t try to collect here; but the process doesn’t always work. You’re better off getting the file closed to avoid more mail and risk of an incorrect collection process.
Question (from a carrier representative): Is there a good way to tell on liability cases in the MSPR portal which insurance company the case is associated to? If it’s a No-Fault or Workers’ Compensation, we see “case debtor” as an insurance company if it’s ours. But there isn’t a good way to tell on liability claims
Answer: As of August 2021, the Medicare portal will not tell you the associated insurance company. The BCRC representatives will usually provide that information via phone call. That said, because the beneficiary is considered the debtor in Medicare Liability cases, the BCRC does not generally assign an insurance company to that file until settlement. This lack of assignment is why it is important for plaintiffs to break down multi-defendant settlements when reporting them to BCRC.
Question: If the client is Medicare age but Medicare has not paid claims, should you still alert Medicare to the case?
Answer: Yes. The law requires defense report to Medicare. Plaintiffs should do the same to gain control over the file. Like #2 above, you don’t want a Medicare lien file opened longer than it needs to be. Report to open and close so that the lien is zero, stays at zero, and doesn’t stay open to give BCRC an opportunity to try to collect. It’s a lot easier to close a file at zero than to dispute/appeal to reduce the lien. This is true even where the claims BCRC includes are wholly unrelated to the lawsuit. Simply put, get the Medicare file closed as soon as there is a settlement to make your process easier.
Medicare liens are often more complex than meets the eye. If you need help with Medicare liens, Medicaid liens, or any other health insurance lien, contact MASSIVE at [email protected] or 833-466-2774.