Elliott & Smith Law Firm

We Live For Our Clients Success!

Jan 04


In handling a personal injury claim, one must not overlook how to handle the Medicare lien.

As a general rule, when someone turns 65 they are eligible for Medicare. Yet, they may be eligible for Medicare before age 65. But only if the Social Security Administration determines disability.
If Medicare pays for bills caused by a car wreck due to the fault of someone else; there is a lien on the settlement. Some lawyers call Medicare’s lien a “super lien”; since it is rarely waived. Satisfy any lien, if there is a settlement of a personal injury claim and medical bills paid by Medicare. Also take the lien into consideration while resolving the case.

First, notify Medicare.

The letter should contain certain required information about the injury and injured person. Do this as soon as possible; due to the fact that many times it takes forty-five to sixty days for Medicare to respond.

Within forty-five to sixty days Medicare responds with a letter called the “Conditional Payment Notice”. It will specifically state that it is not a bill. It also states not send payment at this moment.

Attached to the Conditional Payment Notice letter will be a Payment Summary Form.

This form lists Multiple services provided.

The form includes providers, diagnosis codes, dates of service, total charges, amount of monies reimbursed, and the conditional payment. It will also contain your total amount of charges, reimbursed amount, and conditional payment amount. Review this document should closely. Verify all bills listed in the Payment Summary are a result of the car wreck. Many times, Medicare will list all medical bills from the date of injury forward. Therefore, it is not unusual to have charges for unrelated medical care listed in the Payment Summary form. Dispute these charges immediately, preferably on the Medicare Portal.

The Medicare Portal is a new website that allows the injured person to quickly and easily get up-to-date information and figures.

The portal is the best way to dispute charges related to the liability injury claim. The portal allows the injured person to submit a written statement and supporting documentation to Medicare about charges unrelated to the injury. The time frame for a decision from Medicare varies but generally takes 2-4 weeks. Assuming Medicare agrees that the charges are unrelated, they will be removed from the Payment Summary form. The portal allows you to appeal the decision if Medicare disagrees and believes the charges are related.

Upon reaching a settlement with the at-fault party’s insurance company; Medicare should be immediately notified.

Once Medicare receives the information, it normally takes about fifteen to thirty days for Medicare to respond and provide the final demand amount. Medicare will send a letter with the demand amount. When the demand amount due is not paid within sixty days, interest begins to accrue. This happens at an interest rate of 10.125%. That is payable for each full thirty-day period that the debt remains unresolved.

Within ten to twenty days after Medicare receives the check for the demand amount; Medicare will send a letter that is on the subject of “Acknowledgement of Full Payment”.

The letter should state that the amount applied to the outstanding balance due Medicare has been received and that the debt has “been reduced to zero and our file is being closed”. Unfortunately, some insurance companies are requiring a copy of the demand amount letter from Medicare before it will send the settlement check. Some insurance companies will offer to send one check with Medicare’s name as one of the payees. However, this presents a very difficult and long drawn out process in order to get the funds properly disbursed, and should be avoided at all costs.

While this article is not all inclusive, it is a general outline of pitfalls and dangers of handling a personal injury case caused by a third party in which Medicare pays the bills.

Anyone injured in a car wreck should consult an experienced personal injury attorney. Considering there are many other dangers and pitfalls in addition to Medicare liens.

Contact Us or call us today at 479-JUSTICE (587-8423).