Medicare Liens

MSA Advocates, Inc. works to assist our clients with understanding and maneuvering the Medicare Secondary Payer (“MSP”) statute, Section 1862(b) of the Social Security Act 42 U.S.C. §1395y(b). Medicare is not responsible paying for a beneficiary's medical expenses when payment "has been made or can reasonably be expected to be made under a worker’s compensation plan…or under an automobile or liability insurance policy or plan (including a self-insured plan), or under no-fault insurance." However, should conditional payments be issued, CMS/Medicare is entitled to reimbursement. Conditional payment are any payments made by Medicare for which another payer is responsible (as set forth in 42 C.F.R. § 411, subparts C through H).

CMS/Medicare lien compliance can often be a time-consuming process. Allow our office to free up resources with the variety of services we offer including:

  • CMS/Medicare Lien Conditional Payment Reporting

  • Review of initial conditional payment letters

  • Disputing of lien conditional payment letters

  • Attainment of Final Demand and Case Closure

  • Hearing Attendance when necessary

Medicare Conditional Payment Q&A

Q: If my client is Medicare eligible and receives a settlement, are they required to reimburse Medicare for any conditional payments made by Medicare for treatment of the injuries related to the date of loss?  

A: Yes.  Under the Medicare Secondary Payer (MSP) Statute, which can be found at 42 U.S.C. §1395y (b), Medicare does not pay for any services for which payment has been made or can reasonably be expected to be made promptly "under a workmen’s compensation law or plan of the United States or a State or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no-fault insurance." 42 U.S.C. §1395y (b)(2)(A)(i)(ii). Therefore, these insurance policies or plans are the "primary plan" and Medicare is considered the "secondary plan" for the payment of related medical expenses and entitled to reimbursement. Therefore, if the claimant/beneficiary will collect a “settlement” under one or more of these insurance plans, CMS/Medicare may assert their rights to collect conditional payments made.  In addition, an insurance claim may have more than one conditional payment/lien demanded by CMS/Medicare for the same date of loss that can expose all parties to the claim for reimbursement.  Please call MSA Advocates, Inc. for more information. 

Q: Can CMS/Medicare open multiple liens for a specific date of the incident?

A: Yes. Medicare establishes liens based on the various policies of insurance related to a specific incident and the carriers’ Section 111 reporting that is mandatory under the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA).  Therefore, parties may have more exposure to CMS/Medicare than one lien/conditional payment demand.  This could leave parties exposed for unpaid liens to CMS/Medicare during or after settlement.  Please call MSA Advocates, Inc. for more information.

Q: If there are multiple policies of insurance responding to the same date of loss can Medicare roll conditional payments between the policies of insurance?

A: Yes, and parties should be aware that this is commonplace when there are multiple liens set up by CMS/Medicare by virtue of the carrier’s Section 111 reporting requirements.  Please call MSA Advocates, Inc. for more information.

Q: If there are multiple defendants in a case and the case settles with one but not all of the defendants, must settlement be reported (either by the claimant, the claimant’s attorney, or the carrier) at that time, or should I wait until the case is settled with all defendants?

A: Yes. The settlement should be reported as soon as possible to Medicare so that any reimbursement that is owed can be made.  Call MSA Advocates Inc. for assistance.

Q: Are there any options available for reimbursement to Medicare if the settlement that the claimant/beneficiary will receive is minimal?

A: Yes. Medicare offers several options to mitigate the lien in these circumstances.  Please call MSA Advocates, Inc. to discuss these options further at 315-472-7965.

Protecting your interests and knowledge is our strength

MSA Advocates, Inc.'s goal is to provide our clients an overall detailed understanding of the Medicare Secondary Payer (MSP) Statute and CMS/Medicare's Rules as they apply to this Statute, without bias. Our clients will have the understanding and knowledge to make sound business decisions relative to the MSP process.