Question: Can a hospital bill Medicare and try to issue a lien against the patient, at the same time? I have a hospital that billed Medicare and due to an improper coding error, Medicare did not pay the bill. Does Medicare have to pay to lift the hospital's lien or is billing Medicare sufficient to trigger a release of the hospital’s lien against my client?
Answer: In short, a hospital cannot submit bills to Medicare for reimbursement and attempt to assert a lien on the same matter. It must choose one or the other.
Providers have 12 calendar months from the date of service to submit a claim to Medicare. If for any reason they submit an untimely claim, they cannot bill the beneficiary except for co pays/deductibles.
Once a provider bills Medicare, the provider must withdraw all claims/liens against the liability settlement (except for claims related to services not covered by Medicare and for Medicare deductibles and coinsurance). This applies even if Medicare did not pay the claim or if the provider refunded payment received back to Medicare. If the provider collected on a lien after billing Medicare, then the provider must issue refund to Medicare or the patient as set forth at this section. Medicare Secondary Payer Manual, Chapter 2, § 40.2.
42 U.S.C. § 1395cc(a)(1) requires that Medicare providers file agreements "not to charge [except deductible or coinsurance amounts] any individual or other person for items or services for which such individual is entitled to have payments made under this sub-chapter." The First Circuit held that the Medicare statutory language, including 42 U.S.C. § 1395cc(a)(1), barred a hospital from balance billing the third party settlement, where the hospital was paid by Medicare, and then the claimant's personal injury claim settled with payment of the Medicare lien. Rybicki v. Elliot Hospital, 792 F.2d 260 (1st Cir. 1986).
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