August 01, 2012

Medicare Lien Update:  Let Your Voice Be Heard


One of the major hurdles in settling personal injury cases is getting both sides to agree on the Medicare lien language in the settlement agreement; indeed, resolving Medicare reimbursement issues is often a prerequisite to many personal injury settlements.  But even when the parties seek to comply with the current reimbursement laws, they may find the process unwieldy, time-intensive and uncertain – in large part because of Medicare’s inability to provide both clear guidance and timely responses.

Two new and exciting developments in the Medicare world seek to address this situation, and may help you and your client successfully navigate the reimbursement process.

New On-Line Portal for Expedited Resolution of Medicare Liens
Beginning this month, the Centers for Medicare and Medicaid Services (CMS) implemented a new web-based tool called The Medicare Secondary Payer Recovery Portal.  This portal is designed to help you and your client comply with the Medicare Secondary Payer Act of 1980 (MSP) – under which Medicare has a right to reimbursement of medical fees in every personal injury settlement where the plaintiff is a Medicare beneficiary – and the Medicare, Medicaid and SCHIP Extension Act of 2007, which requires insurers and businesses to report claim information when there is a possibility of Medicare reimbursement.

Since Medicare can go after any party who has a reimbursement responsibility, complying with the MSP is in the interests of both plaintiffs and defendants.  The Medicare Secondary Payer Recovery Portal will help the process by enabling attorneys, insurers, beneficiaries and TPAs to access and update case specific information online, including:

--Requesting conditional payment information
--Disputing claims included in a condition payment letter
--Submitting case settlement information

Let Your Voice Be Heard 
CMS has also issued an Advanced Notice of Proposed Rule-Making regarding “Medicare Secondary Payer and Future Medicals.”  CMS has provided seven different future medical options and is inviting the public to propose additional options during the comment period.  These options relate to both liability and workers’ compensation settlements.

Your comments may help this cumbersome process become more user-friendly – so let your voice be heard!  You may learn more information about the options and comment on the proposed rules at

Filed Under: Mediation

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