What to Expect When Expecting (a settlement)

what to expect

Typically, Medicare liens are automatically “placed” on the personal injury case of a person whose treatment is paid by Medicare. Medicare’s agents, the BCRC, CRC, and CMS have a right to recover funds which would not have been paid without the negligent act which harmed the plaintiff-beneficiary.  If you are the Medicare beneficiary and plaintiff in a lawsuit, your attorney (or, as their agent: a professional lien resolution organization) should handle the Medicare liens for you.  If you are the attorney, but you don’t know how to handle the lien, or just need some help, follow these simple steps:

  1. Report the case to the BCRC
    1. Call (855) 798-2627
    2. Be prepared to give the following Plaintiff/Beneficiary information:
      1. Name
      2. Social Security Number
      3. Medicare Number (a/k/a HIC Number)
      4. Date of Birth
      5. Address
      6. Date of Incident
      7. Injury (the BCRC prefers physical body parts, e.g., “Back,” rather than lumbar strain)
      8. Defense insurance (if known)
  2. Wait 10-15 days.  During this time period the BCRC will create its internal file.  At the end of this time period you may receive two (2) pieces of Medicare lien information from the BCRC:
    1. First, you may receive a Beneficiary Information Questionnaire (you will recognize this document based on the red grid lines on the back pages).  This document can be ignored if, and only if, the plaintiff-beneficiary’s information has not changed.
    2. Concurrently, you will receive a Rights and Responsibilities Letter.  This will give some information on the Conditional Payment Letter process.  No action on your part is required.
      1. This Rights and Responsibilities Letter starts a countdown until you should receive a Conditional Payment Letter (a/k/a the initial lien).  That countdown will last up to 65 days – however, you need something else to receive the letter.
      2. Authorization is Required. Within a few weeks, you must send consent to release and proof of representation to the BCRC.  If you do not send this authorization, you will not receive information on the Medicare lien, nor will you be able to speak to BCRC representatives regarding your case.
        1. Unfortunately, the BCRC is notoriously slow.  Without constant checks on the status and timeline, your Conditional Payment Letter may not arrive within the 65 day period.
          1. The BCRC also often fails to attach your authorization to the file. Be sure to call the BCRC to check the status of your authorization (its validity).
          2. For best results, be sure to call the BCRC multiple times after to check the status of your Conditional Payment Letter.
          3. Please be ready to wait when you call the BCRC. Hold times are much better than the MSPRC’s early aughts hold times, but they still range anywhere from 5 to 25 minutes.
          4. The BCRC also offers a callback option that works very well.
  3. After all that time and effort you should receive the Conditional Payment Letter on time.
    1. But if you did not bother to call the BCRC – you probably don’t have it!
    2. You’ve received the Conditional Payment Letter, now what?
      1. Review the payments.  Check every ICD-10 code and injury to make certain they relate to the plaintiff’s sued-for injuries.
  4. On nearly every Conditional Payment Letter there will be unrelated codes – this means the lien is too high and Medicare is claiming funds to which it is not entitled.
  5. If you have time before settlement you should Dispute the Conditional Payment Letter.
    1. The BCRC requires these dispute in writing – either via fax or its online portal.
    2. Dispute the codes that are unrelated and explain why the BCRC was wrong to include them.
    3. Be detailed.
    4. The BCRC should take 30 days to review your dispute. When it replies to your dispute it will not give reasons, it simply sends a new Conditional Payment Letter.
    5. The case is settled, how do I pay Medicare?
      1. First you have to request a Final Lien Demand by notifying the MSPRC of settlement.
        1. Be sure to include the settlement, attorneys fee, any costs incurred (plus an itemization), and the date of settlement.
        2. In 30-45 days you will receive a Final Lien Demand.  This is the amount you must pay to Medicare from the settlement proceeds.
          1. You have 60 days to repay the lien before interest accrues.
          2. If you fail to pay within 60 days the interest will accrue for all 60 days plus any additional time.
  6. A Final Lien Demand is not really final:
    1. You can appeal the Final Lien Demand on the basis that unrelated payments are included in the lien.
      1. You must do so within 120 days.
      2. Be very careful and detailed when appealing.  Keep in mind the BCRC is the judge, jury, and executioner at this point of the Medicare lien appeal.
      3. Payment: We suggest you pay the lien even while appealing – as interest will accrue on any amounts that are owed.
    2. Other methods exist to lower the lien, including:
      1. Compromises with CMS Regional Offices.
      2. Waivers (truly: financial waivers) through the BCRC using Social Security Administration documents.
    3. Now that I won the appeal, how does my client get a Medicare Lien Reimbursement?
        1. Medicare lien reimbursements (for “overpayment”) take 2-14 weeks to be processed and sent to your client.
        2. You don’t have to do anything once the appeal has been agreed to by the BCRC.
          1. But the check will go straight to the organization who paid the lien.
          2. If you want the check to go to your office you must contact the BCRC and request it be sent to you.
            1. Usually this check arrives as a two-party check.
            2. This will protect the interests of all heirs who have an entitlement to the lawsuit funds.
            3. Now you can put the check into your escrow account and disburse the funds as is legal, ethical, and agreed to by the plaintiff, heirs, and secondary lienholders.
  7. Timelines:
    1. Reporting to BCRC – Day 1
    2. BCRC file “creation” – Day 3-5
    3. BCRC sends Rights and Responsibilities letter, starting 65 day countdown to a Conditional Payment Summary, or Initial Medicare Lien – Day 12-15
    4. Conditional Payment Letter arrives – between Day 30-80
    5. Disputes add 21-56 days
    6. Compromises add 60-120 days
    7. Appeals add 30-90 days
    8. Notice of settlement to receive Final Lien Demand
      1. Depending on method used – 10-30 Days
      2. If you do everything right in Medicare Lien Resolution, you could resolve a lien within 90 days; but, if you let letters sit and do not take the time to carefully review and resolve your liens, they could take years.
        1. Report early;
        2. Follow-up with BCRC often; or,
        3. GET HELP! MASSIVE: Medical and Subrogation Specialists specializes in this process.  When we see a Medicare letter, we know what to do with it – reducing lag time and speeding up the lien resolution process.  MASSIVE makes lien resolution our focus; we take this administrative work off of your plate, providing you with time to practice law and litigate cases.
        4. Best of all – The cost of lien resolution is billable to the client, just like an expert fee. The attorney pays nothing; and, while the client pays a small fee, he or she ultimately benefits by a reduced lien, faster disbursement, and effective results.
        5. Contact us for all of the above.