How to Resolve a Medicare Lien when Settling a Personal Injury Claim

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Posted about 6 years ago. 55 helpful votes

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1

Report claim to COB.

Report the claim to the Coordination of Benefits Contractor for the Centers for Medicare and Medicaid Services (CMS). Contact information for the COB Contractor and the information to be provided to the contractor is contained at the CMS website, www.cms.hhs.gov.

2

Request Conditional Payment letter.

Make a written request to the Medicare Secondary Payer Recovery Contractor for CMS for a "conditional payment letter" showing any payments made by Medicare for the injury. Provide the MSPRC with the claimant's name, address, date of birth, Medicare number, date of injury and nature of injury.

3

Audit the conditional payment listing.

Carefully review the conditional payment letter sent by the MSPRC since it often will list Medicare payments for medical treatment completely unrelated to the claim. Any conditional payments for unrelated treatment should be challenged, with documents evidencing the nature and extent of the claim injury provided.

4

Provide final settlement documents.

Once the claim is settled, provide the MSPRC with a copy of the settlement document and information on attorney fees and costs paid by the claimant. Medicare is required to offset its recovery by a proportionate share of the attorney fees and costs. The MSPRC will prepare a final demand for payment letter showing the amount it claims Medicare is entitled to recover from the settlement.

Additional Resources

Details on dealing with Medicare conditional payment liens can be found on the CMS website, www.cms.hhs.gov

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Types of personal injuries

There are many types of personal injuries for which financial damages can be awarded, including physical, emotional, and psychological injuries.

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