Medicare and Medicare Reimbursement - Call Lee Free

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Medicare and Medicare Reimbursement

Medicare has become an important part of almost every single claim in our office, whether it is a car accident, truck accident or slip and fall accident.

First, there is the paperwork. Whether the client is on Medicare or not, the insurance company on the other side wants information pertaining to Medicare. Recently, a client in his mid 20s who was in great health until he was involved in a car accident was mailed seven pages of information pertaining to Medicare by his auto insurance company. My client is not on Medicare and hopefully will not be Medicare eligible for another forty years. Now often insurance companies send this documentation to obtain free information on the case that has nothing to do with Medicare. But most of the time they are just trying to abide by federal law. Still, the paperwork and time involved in just notifying Medicare of an open claim has gotten ridiculous.

Then there is the major headache. Paying Medicare the money it is owed. Under the Medicare Secondary Payer Act, the Medicare Trust Fund is entitled to recoup the money it has spent on behalf of a beneficiary injured from the liability of someone else. This makes sense. Medicare has paid the beneficiary’s medical bills for an accident that a private insurance company is responsible to pay. It wants its money back.

However, because the U.S. Department of Health and Human Services, which runs Medicare, so under staffs the Medicare department responsible for collections, it has become virtually impossible to find out the amount of Medicare’s lien and what charges Medicare has a lien for. As a result, our clients sit and wait for the compensation they deserve, even after the case has been resolved.

The problem is only getting worse. Wait time for the “final payment letter” from Medicare on our various Michigan car accident cases or Michigan no-fault cases now runs into the months and months. We have settlement checks in the six figures sitting in our office, unclaimed by our clients because under federal law, we cannot disburse the settlement money to the client until Medicare’s lien has been satisfied. Of course you cannot satisfy a Medicare lien unless you know what the final lien amount is in the first place!

Complaints to the various parties in the federal movement have been made. Kathleen Sebelius, the Secretary of the Department of Health and Human Services, a cabinet position, has been made aware of the vast under staffing in the Centers for Medicare & Medicaid Services (CMS). However, with calls to cut all forms of federal government spending being made daily by the Republican majority in the House of Representatives, it is unlikely new funding will be found to hire the people necessary to collect the money Medicare is owed.

Think about that for a second. You have hundreds of millions in accounts receivable outstanding. It will only cost a few million dollars to hire new staff and implement the infrastructure necessary to speed up the collections process. Sounds like a no brainer, right? Well, only time will tell. And hopefully the federal government will take the steps needed to speed this process up, both for the solvency of Medicare and our injured clients.