FAQs
How long does the lien resolution process usually take?
When should a claim be reported to the Medicare Coordination of Benefits Contractor (COBC)?
Can I release funds to my client before the lien has been resolved?
How much can Medicare Recover?
What if my client decides not to resolve his outstanding liens? Is there anything I can do?
Can our client lose their benefits after receiving a settlement?
What is Medicare’s position in regards to exposure cases, like Asbestos and Benzene?
Is my client’s Employee Benefit Plan an ERISA plan? Do we have to pay a lien?
How long does the lien resolution process usually take?
Anywhere from 30 days to 5 months, depending on the type of lien(s). Medicare’s guidelines allow for 30-45 days to respond to each request, making the full resolution of a Medicare lien possible in 2 ½ - 4 months. Some situations, like compromises or waiver requests, may extend the timeframe for Medicare resolution to six months or more. Resolution time for Private/ERISA plans, Medicaid liens, and VA/ Tricare liens vary, as these agencies do not abide by the same guidelines as Medicare’s contractors. LSS associates are focused on effective case management that ensures quality as well the shortest turnaround time possible.
When should a claim be reported to the Medicare Coordination of Benefits Contractor (COBC)?
A claim should be reported to the COBC when medical services have been rendered to a Medicare beneficiary that is related to Liability, Workers Compensation, and /or No Fault claims. Due to there being a primary payer in these instances, Medicare is entitled to full reimbursement of any conditional payments that have been made by Medicare. For this reason, it is crucial that you and your client comply with the MSP laws that have been put in place to ensure the integrity of Medicare Trust Funds.
Can I release funds to my client before the lien has been resolved?
It is not suggested that funds be released before the liens are resolved and confirmed in writing, either by a final confirmation letter from the lien holder/recovery agent or a Final Demand from Medicare. In cases where there may be need-based benefits such as Medicaid/SSI, the distribution of funds may affect the claimant’s eligibility. Distributing funds before a valid lien is resolved can have consequences for both attorney and client (see below). However in some cases, if there is a guarantee that a lien holder will not increase their lien amount, a holdback may be recommended.
How much can Medicare Recover?
Medicare (CMS) can recover the total amount of conditional payments made for injuries related to a Liability, Workers Compensation, and/or No Fault claim up until the date of settlement. Medicare does have the statutory right to request full reimbursement for the full amount of the settlement if the total amount of related charges is equal to or greater than the settlement amount. If reimbursement is made as a result of a settlement, judgment or award, Medicare will deduct the procurement costs (e.g. attorney fees and additional expenses).
What if my client decides not to resolve his outstanding liens? Is there anything I can do?
In a situation where a claimant has been awarded funds, and is responsible for resolving all outstanding liens with their respective lien holders, some may choose not to pay their insurers for benefits previously received. It is not a good idea to advise a claimant to “spend down” or divert funds into a trust or other type of investment. In fact, the avoidance of repaying valid liens may put the attorney in a position where both you and the claimant are liable for the outstanding liens as well as any penalties. It is the attorney’s responsibility to educate their client about their obligation to address and resolve all liens. Lien holders may be within their rights to seek recovery directly from the claimant even if funds have been distributed, with no definite statute of limitations. If a Medicare lien is involved, failure to address Medicare’s interest can result in the accrual of interest and the garnishment of Social Security benefits until the debt is repaid. Claimants must be made aware of their contractual obligations and the possible consequences before being allowed to make such an important decision.
Can our client lose their benefits after receiving a settlement?
If your client is receiving a needs based (low income) benefit like Medicaid or SSI, a settlement award may affect their benefits. LSS can assist in preserving your client’s eligibility through our affiliated firm, Delta Settlement Solutions.
What is Medicare’s position in regards to exposure cases, like Asbestos and Benzene?
“As the Medicare Secondary Payer (MSP) liability provisions were effective December 5, 1980, Medicare may have a recovery claim whenever there was asbestos [or benzene] exposure on or after December 5, 1980. Medicare’s claim would be for all Medicare reimbursed services on or after December 5, 1980, which are related to the liability settlement, judgment, or payment. Medicare’s recovery claim is based upon specific Medicare reimbursed services rather than some percentage of the liability settlement, judgment, or payment. Consequently, MSP law does not provide for any type of pro-rata reduction based upon the dates of any exposure.”
As the number of Asbestos and Benzene Exposure cases increase, Lien Settlement Solutions recognizes the specific demands Medicare’s position has placed on the Asbestos and Benzene communities. We have developed pre-screening and reporting processes exclusively for the compliant resolution of these cases.
Is my client’s Employee Benefit Plan an ERISA plan? Do we have to pay a lien?
ERISA stands for the Employee Retirement Income Security Act, which allows private employee benefit plans (excluding federal government or church plans) to assert liens in settlements where there is a third party responsible for injury or incident related care. ERISA states that a plan must have a subrogation clause in order to be provided “appropriate equitable relief” (29 USC 1132(a)(3)) or the fair repayment of their lien. Upon evaluation of the insurers’ plan type (Insured or Self –Funded), specific plan description language and state statute, we will be able to determine if a lien is exempt from repayment or whether it is subject to negotiation.
LIEN Settlement Solutions, LLC
4025 Edgewater Drive
Orlando, FL 32804
Toll Free 877.907.LIEN (5436)
Facsimile 877.408-8194
