3 Medicare Problems Every Trial Attorney Must Solve for Their Clients. Jack Meligan is the founder of The PLAINTIFF’S MSA AND LIEN SOLUTION, and he teaches that there are 3 Medicare problems every trial attorney must solve for their Medicare clients.
#1 – THE MEDICARE CONDITIONAL PAYMENTS ISSUE
The FIRST of three Medicare problems trial attorneys must solve is the Medicare conditional payments issue. This is the “past medical” that Medicare wants repaid at the time of settlement, or just after.
Not only is there the very REAL threat of “double damages” for missing this with Medicare or a Medicare Advantage Plan (as Paris Blank trial lawyers discovered – www.plaintiffsmsa.com/can-firm-take-punch-mouth ), there’s more. NOT dealing with Medicare conditional payments in a timely manner can cause a huge time delay in getting defendants to pay over an agreed-upon settlement amount.
The hold up? Most defendants are demanding to see a copy of Medicare’s Final Conditional Payments Demand Letter BEFORE letting go of the settlement check. However, this is not easy to obtain. The process with Medicare can take 90 to 120 days—even longer. Thus, starting well in advance of a possible settlement date is imperative if you want to avoid disappointing your client, your bookkeeper, or your banker.
#2 THE QUESTION OF MSAs AND FUTURE MEDICARE LIABILITY
The SECOND of three Medicare problems trial lawyers must solve involves MSAs and future Medicare liability. MSAs are absolutely NOT required by law. However, that fact misses the bigger point. The bigger point is that the law making Medicare SECONDARY to all forms of insurance dates back to 1980. Almost 37 years. Consequently, ignorance of the law is no defense.
When Medicare is notified, or otherwise discovers, that your client has a settlement that includes compensation for future medical, Medicare is PRECLUDED from paying. Then, they will notify your client. When your client gets a letter from Medicare denying payment, and they have no money left from their settlement to pay with, who are they going to call? YOU.
Hence, advising your client on the reason for and against creating a voluntary minimalized MSA account, with or without professional administration, is imperative. Especially if you want to avoid having an uncomfortable phone call from your client sometime down the road.
#3 THE SECTION 111 SETTLEMENT REPORT
The THIRD of three Medicare problems trial lawyers must solve is the Section 111 Settlement Report. Medicare LEGALLY requires defendants to submit this report on the date of settlement, and it has 196 data points!! Now, not all of them are filled in on every report or any one report. The one that is CRITICALLY IMPORTANT to your client is the complete list of all the ICD-9 or 10 codes. These codes identify the treatments for your client’s injuries or conditions that are the subject of their settlement. The problem? This information goes into your client’s common working file at Medicare. Their job is to match these codes with future billings and DENY payment for bills that reference those same codes.
There have already been numerous instances where defendants have misreported or even negligently reported pre-existing conditions, OR EVEN SOME OTHER PLAINTIFF’S CONDITIONS, to Medicare. When this happens, your client can be erroneously denied payment from Medicare for those services. This can cause a lot of potential problems. Maybe even life threatening ones. Furthermore, it takes a trip to an ALJ to straighten out the mess.
Therefore, adding language to your Settlement Agreement and Release that PREVENTS or STRICTLY LIMITS the potential damage that a defendant’s negligent Section 111 Report to Medicare/CMS can cause, is imperative if you don’t want to have to fix one of these messes.
THE BOTTOM LINE
Do you want or need help with any, or all of these? The PLAINTIFF’S MSA AND LIEN SOLUTION has the answers. email us or give us a call. We are ready to help you.
Protect your clients and save them money, as well as future hassles with Medicare. We will take all of these Medicare problems off of your desk, along with the hassle, worry and expense of compliance, so you can rediscover the joy of why you got into plaintiff’s trial law to begin with.
We are The PLAINTIFF’S MSA AND LIEN SOLUTION.
YOUR Medicare Problem Solver.