Typically, Medicare liens are placed on the personal injury case of a person

whose treatment is paid by Medicare. Medicares agents, the COBC,

MSPRC, 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
should handle the Medicare liens for you. If you are the attorney, but you
dont know how to handle the lien, or just need some help, follow these
simple steps:
1. Report the case to the COBC
I. Call (800) 999-1118
II. Be prepared to give the following Plaintiff/Beneficiary information:
i. Name
ii. Social Security Number
iii. Medicare Number (a/k/a HIC Number)
iv. Date of Birth
v. Address
vi. Date of Incident
vii. Injury (the COBC prefers physical body parts )
viii. Defense insurance (if known)
2. This should be the only time you deal with the COBC
3. Wait 10-15 days. During this time period the COBC will transfer the
file to the MSPRC, another Medicare agency. At the end of this time
period you should receive two (2) pieces of Medicare lien information
from the MSPRC:
I. First, you will 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-beneficiarys information has not changed.
II. 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.
i. 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 65 days
however, you need something else to receive the letter.
ii. Within the 65 day period, you need to send consent and
proof of representation to the MSPRC. If you do not send
the consent, you will not receive information on the
Medicare lien, nor will you be able to speak to MSPRC
representatives regarding your case.
A. Unfortunately, the MSPRC is notoriously slow. Without
constant checks on the status and timeline, your
Conditional Payment Letter probably wont arrive
within the 65 day period.
a. Be sure to call the MSPRC to check the status of
your consent (its validity).
b. Be sure to call the MSPRC multiple times after to
check the status of your Conditional Payment
Letter.
c. Please be ready to wait when you call the
MSPRC. Hold times range anywhere from 10
to 55 minutes (and increasing). In fact, due to
the MSPRCs inability to handle current
volumes of mail, its call center is now closed
on Fridays.
4. After all that time and effort you should receive the Conditional
Payment Letter.
I. But if you did not bother to call the MSPRC you probably dont
have it!
II. Youve received the Conditional Payment Letter, now what?
i. Review the payments. Check every ICD-9 code and injury to
make certain they relate to the plaintiffs sued-for injuries.
A. Hint: ICD-9 Code 250.00 (Diabetes Mellitus) usually
does not relate to malpractice or a personal injury.
5. 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.
6. If you have time before settlement you should Dispute the Conditional
Payment Letter.
I. The MSPRC requires these in writing.
II. Dispute the codes that are unrelated and explain why the MSPRC
was wrong to include them.
III. Be detailed.
IV. The MSPRC will take 60-90 days to review your dispute. When it
replies to your dispute it will not give reasons, it simply sends a
new Conditional Payment Letter.
V. The case is settled, how do I pay Medicare?
i. First you have to request a Final Lien Demand by notifying
the MSPRC of settlement.
A. Be sure to include the settlement, attorneys fee, any
costs incurred (plus an itemization), and the date of
settlement.
B. In 30-45 days you will receive a Final Lien
Demand. This is the amount you must pay to
Medicare from the settlement proceeds.
a. You have 60 days to repay the lien before interest
accrues.
b. If you fail to pay within 60 days the interest will
accrue for all 60 days plus any additional time.
7. A Final Lien Demand is not really final:
I. You can appeal the Final Lien Demand on the basis that unrelated
payments are included in the lien.
i. You must do so within 120 days.
ii. Be very careful and detailed when appealing. Keep in mind
the MSPRC is the judge, jury, and executioner at this
point of the Medicare lien appeal.
II. Other methods exist to lower the lien, including:
i. Compromises with CMS.
ii. Waivers through the Social Security Administration.
iii. Now that I appealed, how does my client get a Medicare Lien
Reimbursement?
A. Medicare lien reimbursements (for overpayment) take
10-14 weeks to be processed and sent to your client.
B. You dont have to do anything once the appeal has
been agreed to by the MSPRC.
a. But the check will go straight to the last-known
address for the beneficiary.
b. If you want the check to go to your office you must
contact the MSPRC and request it be sent to
you.
a. Usually this check arrives as a two-party
check.
b. This will protect the interests of all heirs who
have an entitlement to the lawsuit funds.
c. 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.
8. Timelines:
I. Reporting to COBC Day 1
II. COBC transfer to MSPRC Day 3-5
III. MSPRC sends Rights and Responsibilities letter, starting 65 day
countdown to a Conditional Payment Summary, or Initial
Medicare Lien Day 15-20
IV. Conditional Payment Letter arrives Day 80-85
V. Disputes add 60-90 days
VI. Compromises add 60-90 days
VII. Appeals add 60-90 days
VIII. Notice of settlement to receive Final Lien Demand
i. Was 10-21 days
ii. Now is 30-45 days
iii. If you do everything right in Medicare Lien Resolution, you
could resolve a lien within 110 days; but, if you let letters
sit and do not take the time to carefully review and
resolve your liens, they could take years.
A. Report early;
B. Call often; or,
C. GET HELP! Lien Resolution Services 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. LRS makes lien
resolution 100% of our focus; we take this
administrative work off your hands providing you
with time to practice law and litigate cases.
D. 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 results.
Contact us for all of the above.