MEDICARE
When Medicare has made payments for medical care and the beneficiary receives a settlement for the injuries that caused the need for treatment, Medicare must be repaid. That is why it is called a “conditional payment”. The question is how much should be repaid. Medicare will issue a Conditional Payment Amount and reduce that amount by the beneficiary’s procurement costs. Sometimes the amount of Medicare’s payments exceeds the gross settlement. In that situation, Medicare allows the attorney to take their fee but then demands the rest of the recovery. This is unfair and inequitable to the Medicare beneficiary who suffered a personal injury. The good news is that Medicare will issue a refund after paying the final demand!
If you are an attorney who admittedly knows very little about the Medicare process, Synergy is your Medicare resolution partner. If you are an attorney who knows some about Medicare but it’s a thorn in your side and you’d rather not have to contend with the red tape, Synergy is your Medicare resolution partner. If you are an attorney who believes you get a great result with Medicare but want to see if a better reduction is possible, Synergy is your Medicare resolution partner.
Synergy has intimate knowledge of the Medicare process and knows what works and what does not work to achieve the best reduction possible. Why spend the time, incur expense, or be frustrated when Synergy can handle it all for you?
How We Get Results
Synergy’s team of Medicare experts have developed expansive understanding on Medicare processes and what works to obtain reduction and what does not.
Some attorneys only want the third-party case reported to Medicare, to obtain a final demand and pay Medicare. Synergy can help you do that. But we can also fully review Medicare’s interest and assess whether there are claims that can be removed or whether arguments allow for Medicare to significantly reduce their reimbursement claim.
What is Medicare and How to Identify
Obtaining a copy of your client’s insurance benefit card is always the best way to identify the appropriate entity with a possible lien interest on the settlement funds. For Medicare, your client may have traditional Medicare or a Medicare Advantage plan.
Medicare is a government program that provides health insurance benefits to those above 65 years of age, the disabled, and those with end-stage renal disease. 42 U.S.C. § 1395c. The Medicare Secondary Payer (MSP) statute, enacted in 1980 with the intention of reducing skyrocketing federal health care costs and protecting the integrity of the Medicare system. It made Medicare the secondary payer for medical services provided to Medicare beneficiaries whenever payment is available from another primary payer like a liability insurer, no fault or workers compensation carrier.
Laws/Legal Implications
The MSP requires Medicare beneficiaries exhaust all available insurance coverage before looking to Medicare’s coverage. The MSP statute prohibits Medicare from making any payment to a beneficiary for medical expenses if payment has been made or can reasonably be expected to be made promptly under an automobile or liability insurance policy or plan (including a self-insured plan) or under no-fault insurance. 42 U.S.C. § 1395y(b)(2)(A)(i).
If Medicare does make a payment, it is a “conditional payment” and if any other party later becomes responsible for payment of services already paid for by Medicare, then Medicare must be repaid. Medicare can seek repayment of their “conditional payments” from any party associated with the settlement of the personal injury action, including the attorneys.
Once the underlying personal injury action has resolved settlement information needs to be provided to the Benefits Coordination and Recovery Center. Medicare will then issue Final Demand which must be repaid within 60 days or interest will begin to accrue.
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The Synergy team will work diligently to ensure your case gets the attention it deserves. Contact one of our legal experts and get a professional review of your case today.
