Steps For Resolving a Medicare lien

Christopher B. Wigand

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Personal Injury Lawyer

Contributor Level 11

Posted about 3 years ago. 2 helpful votes

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Step One - Contact the Coordination of Benefits (COBC) Hotline

Call the Coordination of Benefits (COBC) Hotline at 1-800-999-1118 to first report the claim. Be prepared to give them the claimant's name, gender, date of birth (DOB), SS#, address, phone number, date of accident (DOA), Medicare number (this is the SS# with an "A" or "B" at the end), and facts of the accident. Once the claim is established Medicare will issue a Rights and Responsibilities Letter (RPL) to the client and send a copy to the attorney.

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Step Two - Contact the Medicare Secondary Payer Recovery Center (MSPRC)

In order for the MSPRC to share information with an attorney they must have a Proof of Representation Letter on file signed by the claimant. This can be sent via facsimile to 405-869-3309 or via U.S. mail to: MSPRC - NGHP P.O. Box 138832 Oklahoma Citym OK 73113 Once the claim is established Medicare will start researching the claim and issue a Conditional Payment Letter (CPL) showing what Medicare paid what they believe is related to the accident.

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Step Three - Check the accuracy of the CPL

After you obtain the CPL you will need to make sure that all of the claims related to the case are included. Make sure that unrelated claims are not included and that related claims are missing. If the claimant or attorney is unsure if a claim is related you can check the diagnosis codes at http://www.icd9data.com If you find claims that are unrelated you must provide written notice to MSPRC explaining what claims are unrelated and why. Make sure to use the Correspondence Cover Sheet as the cover page on anything you send to MSPRC. Medicare will then research the claim and send you an updated CPL. After you get the updated CPL you must read the payout sheet again to see what is related to the accident. Just because you told Medicare what is not related does not mean that they removed everything or did not add anything new. Continue until the CPL is correct.

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Step Four - Notify Medicare of your settlement

Once you have an accurrate CPl showing only what is related to the accident you need to notify Medicare of the settlement by sending them a Final Settlement Detail Document, Medicare will then send you out a Final Demand Letter with the amount of the final lien to be paid. Once you obtain the final lien amount you must submit payment to Medicare within 60 days using their approved Check Remittance form . If payment is not received within 60 days Medicare starts accruing interest and a $1,000 a day fine.

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Final Considerations

Medicare is obligated to reduce the lien for their pro-rata portion of attorney fees and costs. If you are offered a settlement that is equal to or less than what Medicare paid, you may request a pre-settlement compromise. (this can only be done before sending in the Final Settlement Detail Document. After a case has settled a hardship waiver may be requested by using the Social Security Administration "Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate" form. If you disagree with what you owe Medicare you may also file an appeal within 120 days of Medicare's determination letter.

Additional Resources

You can find information on the entire MSPRC process by going to their website at http://www.msprc.info/ The Proof of Representation Letter form can be obtained from the MSPRC's website at http://www.msprc.info/forms/ProofofRepresentation.pdf The Correspondence Cover Sheet can be found at http://www.msprc.info/forms/MSPRC%20NGHP%20Correspondence%20Cover%20Sheet.pdf The Final Settlement Detail Document can be found at http://www.msprc.info/forms/Final_Settlement_Detail.pdf The Check Remittance form can be found at http://www.msprc.info/forms/Check%20Remittance.pdf The Request For Waiver Of Overpayment Recovery Or Change In Repayment Rate form can be found at http://www.socialsecurity.gov/online/ssa-632.pdf

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