Unrelated Medical Expenses Part 2

Challenging Unrelated Medical Expenses on Medicare Liens Part 2

Before you celebrate that settlement, be sure that you have considered Medicare by meeting Medicare compliance requirements. The Medicare program will aggressively pursue a personal injury lien against your plaintiff. If your client is a Medicare beneficiary, it is imperative that these benefits are accounted for and reimbursed to the appropriate program to avoid serious penalties. We encourage you to read part one of our article to learn more.

Dispute the Expenses

If after auditing the Conditional Payment Letter, you find discrepancies, circle them and submit a dispute letter to the MSPRC to have them removed. The MSPRC will review your dispute and send a new Conditional Payment Letter to you in approximately 45 to 65 days. If the MSPRC is an agreement with any of the items disputed, a lower lien amount will reflect this.

Maintaining Compliance

Handling personal injury cases requires due diligence on the part of attorneys. By law, your client must pay Medicare back from their settlement. To avoid exposure to legal damages, it is essential that you establish a process to identify Medicare beneficiaries to ensure both you and your clients meet Medicare compliance. You will need to be prepared to handle the issues that may arise in these types of cases in order to secure your client’s settlement and to avoid personal liability yourself.

Let Our Experts Help You

Medicare liens can be complex and a challenge. It is crucial that you maintain Medicare compliance to avoid serious penalties. Do not wait to partner with a settlement planner because Medicare liens take time to resolve. Additionally, you want to give yourself time to audit your client’s lien report to have all unrelated expenses removed. This will play a key role in preserving as much of your client’s settlement as possible.

Synergy Settlement Solutions has extensive experience navigating the Medicare lien process. The lien process takes some time and will require you to request updates as well as challenge new unrelated items as they appear. We know that every settlement dollar matters, therefore, we are dedicated to assisting you and your clients with the lien recovery process to protect your client’s settlement money and future benefits.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.

TESTIMONIALS

"Synergy has been a trusted part of our legal team for many years. They have helped our clients in many cases to understand the benefits of structured settlements. Synergy has protected our clients and us by securing the best annuities on the market with the safest companies available. Our Synergy consultant is a great communicator in explaining the details and benefits of structured settlements to our clients. He has also mentored myself and the other lawyers in our firm in the benefit of Attorney Fee Annuities. Their work with our firm has secured our clients and our financial security and we expect to continue working with him for many years to come."

Brett Panter
Panter, Panter & Sampedro

"I recently engaged Synergy to assist with a complicated PTD settlement involving a substantial Medicare Set Aside. The claimant’s wife has been providing full time attendant care which is not Medicare covered. The Synergy nurse was able to do a full analysis of non-Medicare covered expenses which far exceeded the value of the MSA analysis performed by the carrier’s contracted MSA provider. The non- Medicare figures became the main focus of the settlement negotiations and more than doubled the value of the case. Although I could estimate the attendant care figures, the nurse added in other items that I would not have routinely considered. I also asked Synergy to evaluate the EC’s MSA as well as their prescription review. Synergy offered insight about the prescription donut hole which I did not have a clear understanding about. Again, their insight and information added a great deal of value to the overall settlement. Not only did I learn from Synergy but was able to educate my clients in the process. These are very complex and complicated areas; I will use Synergy again and again!"

Rosemary Eure
Lancaster & Eure

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