Medicare Liens in Workers’ Compensation

Medicare’s process in Workers’ Compensation is generally misunderstood. The best solution? Remember that Medicare will attempt to collect from any source and any settlement.

 

Medicare will open files relating to a Workers’ Compensation injury in the following manner: 

  1. Recovery from the carrier. This file is via the Commercial Repayment Center (“CRC”). We can call it the “CRC – Work Comp” file. How does it get opened and who is paying it? The CRC will open this CRC – Work Comp file where the carrier’s Section 111 reporting tells Medicare that it has “Ongoing Responsibility for Medicals” (“ORM”). Essentially, a carrier always has ORM to start because most Work Comp is considered no-fault. CRC considers the carrier the debtor and sole payer for this lien file. To make matters more confusing, the CRC may make a demand for payment, receive that payment, and then open a new CRC – Work Comp file where ORM continues. 
  2. Recovery from the claimant’s Work Comp settlement. This file is via the Benefit Coordination and Recovery Contractor (“BCRC”). How does it get opened and who is paying it? The BCRC opens this BCRC – Work Comp file where the plaintiff asks it to do so or where BCRC learns of a settlement via Section 111 reporting. The BCRC considers the plaintiff the debtor and sole payer for this lien file. Under Medicare’s normal processes, this file should be opened even where the carrier takes responsibility to pay for all liens. 
  3. Recovery from the claimant’s negligence settlement. If the claimant sues his or her employer for negligence, there is third file type to consider: BCRC – Liability. How does it get opened and who is paying it? The BCRC opens this BCRC – Liability file where the plaintiff asks it to do so or where BCRC learns of a settlement via Section 111 reporting. The BCRC considers the plaintiff the debtor and sole payer for this lien file. Under Medicare’s normal processes, this file should be opened even where the carrier takes responsibility to pay for all liens. 

 

Ryan Weiner, Esq., COO of MASSIVE, will be presenting “Medicare Lien Resolution in Workers’ Comp Claims” at the virtual Kansas Department of Labor’s 48th Annual Workers Compensation Seminar Wednesday September 28th at 2:20pm (CST). Visit the Kansas Department of Labor website for more information and to register.