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Medicare Lien Procedures & Info

July 13th, 2012 01:20:01 pm


 

Medicare Lien Procedures and Information:

 

 

Medicare Websites:

 

Medicare Lien Procedures and Forms:

http://www.msprc.info/index.cfm?content=main

 

Medicare Claims Paid History for Injured Client:

http://my.medicare.gov/

 

Centers for Medicare and Medicaid Services website:

http://www.cms.gov/

 

 

Opening Medicare Lien Claim:

 

Initially call COBC (Coordination of Benefits Center) & report all injury claim coverages (liability, UM, UIM, self-insured). Also report all policy limits for no fault/PIP and Med Pay coverages.

 

By Telephone

COBC Call Center

(1-800-999-1118)

 

By Mail:

MEDICARE -  Coordination of Benefits

Medicare Claims Investigation Project

P.O. Box 33847

Detroit, MI 48232-5847

 

Have handy your client’s personal and accident insurance information which is necessary to open the Medicare lien file: Medicare identification number (usually the client’s social security number followed by an A,  or sometimes a B, but check your client’s Medicare card or the

Medicare # listed in medical records); date of birth, address and phone; date of accident;and  information regarding liability/UM/UIM carriers, etc. 

 

Be sure to report all applicable coverages:  Liability or self-insured; Uninsured Motorist; Underinsured Motorist; No Fault/Personal Injury Protection policy limits available; Medical Payments policy limits available.

 

Medicare Coordination of Benefits will then mail you a MSP Development Questionairre, which you are to complete and return to the above address.

 

 

Once the above is accomplished, all further contact, whether phone or mail, will be with the following:

 

MSPRC – NGHP       (NGHP is for Non-Group Health Plan)

P.O. Box 138832

Oklahoma City, OK 73113

(866-677-7220)

(405-869-3309 Fax)

 

[Note: All product liability and special projects, use the following contact instead of the above contact:

 

MSPRC – Special Projects

P.O. Box 138868

Oklahoma City, OK 73113

 

Within a few weeks thereafter, you will receive a letter from Medicare which notifies you of the case identification number assigned and which will also reference the client’s Medicare number.

 

Whenever you send anything by fax or mail to the MSPRC, be sure to handwrite the client’s Medicare number at the top right corner of each page. Also, each time you send anything to Medicare, the first sheet should be a completed NGHP Correspondence Cover Sheet (attached).

 

Once there is a case identification number, be sure to send the completed and signed Proof of Representation (attached) to the MSPRC, or Medicare/MSPRC will not discuss or mail you correspondence concerning the lien.

 

Once a case identification number is assigned, Medicare’s time frame is to send a Conditional Payment Letter, with a lien amount and itemization, with 65 days thereafter.

 

If you want to check the status of the Medicare lien, call the MSPRC at (866-677-7220). There is an automated option to give you the current status and current lien amount, if this has previously been determined,  without waiting. Whenever you phone the MSPRC, have handy the client’s

Name, case identification number, date of birth, first five letters of last name, and Medicare and Social Security numbers, as you will need them to access the current status and lien amount info from the automated lien.

 

Once you have a liability, uninsured motorist, underinsured motorist, etc. settlement,  send the completed “Final Settlement Detail Document”, including an itemization of costs and a copy of  the contingent fee agreement. Of course, if there are settlements from more than one insurer/defendant, report them all on  the “Final Settlement Detail Document”.

 

The MSPRC will then do a current lien amount and itemization, apply the procurement cost reduction (pro rata attorney’s fees and costs), and send you the Final Demand Letter, with payment, lien waiver/compromise/appeal instructions.  Payment must be received within 60 days from the date of the Final Demand Letter, or interest will be charged from the date of the  Final Demand Letter, regardless of whether the client files a lien waiver/compromise/appeal.

 

If you later have an additional settlement(s) (whether liability, uninsured motorist, underinsured motorist, etc.), send another completed “Final Settlement Detail Document”, including an itemization of costs and a copy of the contingent fee agreement. Be sure to note the client’s Medicare # at the top right, along with “SECOND” (OR “THIRD”, etc.) SETTLEMENT” as applicable, so that Medicare will hopefully realize that this is an additional settlement from the same date of accident.

 

If at any time the client desires to file a request for lien waiver/compromise/appeal, be sure to have client complete the form SSA-632-BK (attached) and send it along with your lien waiver/compromise/appeal request.



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