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Services - Lien Verification & Resolution

• Medicare Verification & Lien Resolution - The Medicare Secondary Payer Act (“MSP”) is a complex piece of legislation with far reaching impact.  “Under the MSP laws (42 U.S.C. § 1395y(b)),… Medicare may make a conditional payment when there is evidence that the primary plan does not pay promptly, conditioned upon reimbursement when the primary plan does pay … Insurers/WC carriers (as applicable), beneficiaries, and representatives/attorney (s) are required to recognize the obligation to reimburse Medicare during any settlement negotiations.” (www.cms.hhs.gov).
  
  Verification of a Medicare lien is the first step in this process. Through correct reporting and document submission, evidence of a lien will be requested from Medicare.After which an LSS specialist will complete a detailed audit of the payment summary that Medicare has provided.  If there is an affirmative obligation to Medicare, LSS will proceed to the complete resolution of the lien, from Conditional Payment Summary to Final Demand.  All post resolution activities, including appeals; compromises (pre and post settlement) and waiver requests are included in the resolution process.

  The professionals at Lien Settlement Solutions have spent years developing programs that proactively address and resolve Medicare liens.  We have established relationships with the Centers for Medicare and Medicaid Services (CMS), Medicare Coordination of Benefits Contractor (COBC), as well as the Medicare Secondary Payer Recovery Contractor and Medicare Regional Offices, with a positive record of negotiating liens that are fair for both our clients and to the government.  Our services help maintain compliance with the MSP ensuring protection of Medicare’s interests under the Secondary Payer Act.

• Medicare Set-Aside Allocations and Analysis (MSAs) – To insure that Medicare’s interests are properly addressed by the defense’s set aside allocation; we can do an independent review of the proposed Medicare Set Aside allocation. Having an independent analysis will help counsel decide whether the proposed set aside by the defense is sufficient.  Through our partner company, MSA Settlement Solutions, we are able to provide a detailed analysis of the future medical needs for an injured party along with life expectancy determinations to create our allocation recommendations. According to Medicare’s WC provisions, Medicare will not assume “the burden of future medical expenses”, therefore it is important to have a team that will assist in the fair evaluation and set aside allocation with Medicare.  Lien Settlement Solutions and MSA Settlement Solutions are equipped to assist in the complete resolution of your Medicare Set Aside issues.
• MMSEA Reporting Agent – MMSEA Section 111

Section 111 of the Medicare Medicaid SCHIP Extension Act of 2007 (MMSEA) institutes mandatory reporting requirements for Liability, Workers Compensation, and No Fault insurers.  All plaintiffs that are confirmed to be a Medicare beneficiary, where a settlement judgment or award is expected to take place must be reported to the Coordination of Benefits Contractor, putting Medicare on notice of potential recovery. 

If the plaintiff attorney does not verify their client’s Medicare status, disregards the possibility that conditional payments may have been made by Medicare on behalf of their client, and fails to advise their client of Medicare’s right to recovery from the proceeds of the settlement, the attorney may have liability according to the United States Code. .  Protecting Medicare’s subrogation rights under the MSP is vitally important to prevent legal action by the U.S. Government.  Lien Settlement Solutions offers programs that ensure compliance with the MMSEA provisions and the MSP statute. LSS wants to be your partner in the handling of the daunting and tedious tasks that are necessary in order to comply with Medicare’s right to recovery.[Insert MMSEA Timeline]

Medicaid (State Need-Based Plans) Verification & Lien Resolution – State provided, needs based healthcare plans, commonly known as Medicaid also have an independent right of recovery when a third party is responsible.  Medicaid third party recovery practices vary by state, and are sometimes outsourced to recovery contractors.  The process of verifying and resolving Medicaid liens includes reporting to appropriate contractors or state agents for claim investigation. 

The LSS verification process for State Medicaid plans determines if Medicaid has made any payments, and provides Medicaid with accurate information as well as documentation necessary in order to obtain verification of a Medicaid lien.  Once verification of a Medicaid lien has been completed, our specialists will work to resolve the Medicaid lien.   A thorough audit of the payment history will be completed by our Resolution Analysts to confirm that the lien is in fact valid. 

Upon claim retrieval and verification, the lien is resolved to final demand or final compromise.  Post resolution services, such as waivers and compromises, are included at no additional cost.

• Private Healthcare /ERISA Evaluation and Resolution – As healthcare for all has become a top priority, the resolution of private healthcare liens has become an increasingly important part of post settlement resolution.  With over 66% of working aged adults (CDC Survey, 2007) enrolled in some type of private health insurance plan, the need for comprehensive evaluation of these plans is absolutely necessary.  Depending on the plan, the state of origination and even the condition of the claimant, an obligation may not even exist despite what is presented by the supposed lien holder.  The ability to use federal and state law in order to validate a lien can mean the difference between a substantial net settlement to the client, and a settlement that is consumed by unnecessary or invalid liens.  Lien Settlement Solutions can assist with the intricacies of private health lien resolution.

ERISA (Employee Retirement Income Security Act ) - 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 statutes, we can help determine if a lien is exempt from repayment or whether there is a chance of negotiating the final amount of the lien.  

Our process includes the reporting (for cases where the claim originates in an Affirmative Notice State – FL, GA, KY, MI, MN, and MO – and remaining states by specific request) and full resolution of liens for group health plans, ERISA, FEBA, Medicare Part C, Provider and Supplemental Insurance. 

Military Health Benefit Lien Resolution – While the number of active duty military and VA beneficiaries grow, so have the number of issues pertaining to subrogation of VA and TRICARE liens.  For veterans receiving health care benefits in VA facilities, the United States has “the right to recover reasonable charges in repayment for health care benefits provided to a veteran through the U.S. Department of Veterans Affairs from certain third parties who would otherwise be liable for the veteran’s medical care” (38 U.S.C 1729).  Our management of these cases includes the reporting of possible liability to the Department of Veterans Affairs (VA) and/or TRICARE, TRICARE for Life, or TRICARE Prime and ultimate negotiation of a final lien amount.