An attorney colleague of ours recently lamented “My cases often become more work after I settle them!” We wrote this booklet because we hear so many attorneys complain about how difficult it is for them to resolve Medicare reimbursement claims after they settle their clients’ personal injury cases. Too often, it takes many months after a case settles for the attorney and the client to get paid because of all the red tape. If you do not deal with this on a regular basis, navigating through this maze can be incredibly frustrating, especially when your client is calling you every day asking why it is taking so long to get them their settlement proceeds.
The Garretson Resolution Group specializes in settling health care liens and reimbursement claims with federal (Medicare), state (Medicaid) and private / ERISA health insurance providers in single event and mass tort settlements. In fact, GRG evaluated and resolved Medicare and Medicaid’s interest in over 50,000 cases last year alone. Simply put, we know the process.
In this booklet, we give you important information and methods for handling Medicare reimbursement claims. These 36 tips for resolving Medicare reimbursement claims quicker will assist you in moving the process along. However, if all of this seems overwhelming and you would rather spend your time on your busy caseload, you can skip to tip number 36, which explains how GRG can take over this obligation. Our qualifications are rather straightforward – Knowledge, Experience and Compliance.
Among the “tips” are:
Whom should I contact to notify Medicare of a reimbursement situation?
Where do I send my request for a conditional payment listing?
Is the provider required to bill no fault insurance?
Can Medicare still collect reimbursement if my claim for damages did not include “Medical Expenses” or if the medical expenses paid by Medicare were unrelated to the accident in question?
What if the settlement proceeds have been disbursed prior to Medicare being aware of a reimbursement situation?
Should Medicare be expected to accept less than its full recovery amount when other claim holders exist?
How much will Medicare seek to recover if the settlement amount is less than the Medicare amount?
Is Medicare allowed to obtain recovery from a claim, settlement, or judgment based on a survivor's recovery for wrongful death?
Does Medicare enter into pre-settlement negotiations regarding the compromise of the recovery amount?
Can the Medicare recovery amount be waived in favor of the beneficiary?
When is the appropriate time for the attorney to request waiver forms from Medicare?
Once a settlement has been reached, what information is the attorney required to send to the lead contractor (MSPRC)?
What if the liability insurer wants to make the settlement check out to my client AND Medicare?
What Can I Do to Speed Up the Process?
Does Medicare require my client to “set aside” a portion of his/her liability settlement that must be spent down after the settlement on future injury-related care?
How do I address Complex, Permanent Injury Cases?