If you wait until you have a settlement to report a Medicare Liability Claim, you will undoubtedly experience frustration.
The thing to do is to report the Medicare Liability Claim as soon as it comes into your office. Start the process immediately. This is true, even if Medicare pays no medical bills on a liability claim. Currently, all insurance carriers, because of the financial penalties associated with the new Medicare guidelines, want something in writing from Medicare concerning the extent of their lien for all Medicare eligible claimants. Otherwise, you may end up with Medicare as a payee on your settlement check.
The reporting process involves the following steps:
- The first step is to call COBC (Coordination of Benefits Contractor) to report the claim over the phone. (800)999-1118. They are open Monday-Friday 8:00 a.m. to 8:00 p.m., Eastern time. It is now much easier to reach a COBC representative.
- After you do this you will be sent a Consent to Release form that must be signed by your client. This gives you authority to obtain your client’s lien information from Medicare.
- You will then receive a form which is printed in red. This form requires the same information that you gave COBC over the phone. Your client must sign this form.
- About 8 weeks later (if your lucky) you will the receive a conditional payment letter (CPL). This lists the payments for medical bills that MSPRC believes are related to the liability claim. Most often it contains all bills that are paid by Medicare subsequent to the date of the accident. You must send a letter to MSPRC to challenge the relationship of any bills on this list to medical treatment related to the liability accident. You will then receive a revised CPL, or you can file an appeal stating the reasons why all medical bills listed are not related.
- After you reach a settlement, you give MSPRC the gross settlement amount, and your attorneys fees, costs. MSPRC then computes a final lien amount. You will receive a Final Demand Lien Letter from MSPRC after they receive your settlement information. If this is not paid in a timely manner, interest will accrue on the the Medicare lien.
Medicare does take into consideration attorneys’ fees and costs incurred by the recipient in determining the final demand amount. As a result, the conditional payment amount related to the liability claim will be reduced.
If you get the Medicare liability claim ball rolling at the beginning of your client’s claim, all you will need at the end of the claim is the Final Demand Lien Letter from MSPRC.