Medicare's Final Demand

Question: We currently have a case in which the client had Medicare; we received their initial statement showing an estimated lien amount of $8,486.31. When the case settled, we contacted Medicare for their final lien amount with all applicable reductions. They then sent us a final lien amount for $50,009.45. We immediately filed an appeal, but were unable to pay the full amount by the 60 day imposed deadline. After repeated inquiries to Medicare to check the status of the appeal, we have now been told it has been transferred to an outside facility. Medicare failed to meet their 60 day deadline to respond to our appeal and we have been advised the outside facility does not go by Medicare’s deadlines and just handles cases in the order received.

We are currently incurring an 11% interest rate on the balance due since we did not repay Medicare by the deadline and there appears to be no end in sight as to when we will get a response from them.

Please let me know if you have any advice regarding this issue or if you might be able to assist in some way with Medicare. If so, please let me know your fees for services.

I look forward to hearing from you.

South Carolina Attorney

Answer: I spoke with Mary Skinner and Mark Maughan in our office. Here is there assessment:

1. If you are withholding any funds, you should apply those withheld funds to the outstanding balance. If you don’t get a favorable outcome it will at least reduce the amount of interest. If you do obtain favorable decision, then the money will be reimbursed.
2. Medicare has 120 days to respond to any waiver/appeal (60 days to pass it to the Qualified Intermediate Contractor and they have 60 days to respond). Once 120 days have passed, you can seek involvement of a supervisor for case to be expedited.

Please do not hesitate to contact Mark or Mary (704.559.4300) if you would like to discuss further.