The Lien Resolution Group process

Medicare Claim Resolution Process
1-Verification- Find out if client is receiving government benefits
2-Open case with the Centers for Medicare and Medicaid Services (CMS)
3-Request Conditional Payment Summary from Medicare (MSPRC)
4-Review Conditional Payment Summary
5-Dispute unrelated medical claims
6-Request final demand – original demand less unrelated items less procurement costs
7-Request hardship waiver, if applicable
8-Attorney and/or Lien Resolution Center receives Demand letter. Payment is required to Medicare within 60 days of receipt of Demand letter, even if a waiver has been requested.

Medicaid Claim Resolution Process
1-Verification-Find out if the client is receiving government benefits
2-Determine county office handling the case
3-Identify analyst on the case
4-Dispute unrelated medical claims (if not estate case)
5-Request final demand
6-Request hardship waiver if applicable
7-See if Ahlborn is applicable

To engage The Lien Resolution Group
to resolve Medicare/Medicaid Claims
In order for us to determine the services necessary for each individual case we will need the following information submitted:

1-Completed case intake form
2-Signed releases (CMS/SSA)
3-Copy of the Summons & Complaint
4-Copy of the Bill of Particulars
5-Copy of any correspondence with Medicare/Medicaid

If your claimant’s case has settled we will need a copy of the Settlement Statement itemizing the breakdown of the settlement and a copy of the signed Settlement Agreement & Release.

The total costs involved for us to address Medicare/Medicaid’s claims will be $1,800.00. Please process your check made payable to “The Lien Resolution Group”, and reference the name of the claimant on your check.

If you have any questions regarding Medicare/Medicaid claims please contact Brett Newman at 1-800-888-1743.

Please submit all of the requested information above to:

Brett Newman
The Lien Resolution Group
216 Congers Road, Bldg 2C
New City, New York 10956

or email to bnewman@helpwithliens.com

Roger Baron, June 11 Erisa seminar in NY & NJ

New Jersey

“The Evolution and Current State of ERISA Subrogation Law”

12:00 P.M., Thursday, June 11, 2009

Law office of Wilentz, Goldman & Spitzer

Woodbridge, New Jersey

(Complimentary Event Sponsored by 

The Middlesex County Bar Association and

The New York State Academy of Trial Lawyers;

To register, phone Leo Dunn-Fox at 845-678-6172)

 

New York

“The Evolution and Current State of ERISA Subrogation Law”

St Johns University –Tribeca Campus

6:30 P.M., Thursday, June 11, 2009

New York City

(Sponsored by New York State Academy of Trial Lawyers;

To register, phone 518-364-4044)

 

Featuring Presentations by:
Professor Roger Baron, University of South Dakota School of Law
and Brett Newman, The Lien Resolution Group

According to industry statistics, ERISA plans and related insurers are
collecting close to $1 billion per year through the seizure of tort
recoveries or other contractual payments received by insured personal injury
victims. The plans aggressively pursue reimbursement on a "first dollar
priority" basis with absolutely no consideration of the impact reimbursement
leaves upon the insured. Authority for these "reimbursement" claims is
attributed to federal preemption under the auspices of ERISA which was
enacted in 1974. The fact of the matter is, however, that when Congress
enacted ERISA, the ability of a health insurer to seek reimbursement was not
recognized under the law.

This presentation will explore the current legal theories which can be
effectively utilized to defeat or minimize ERISA Reimbursement claims.
Professor Roger Baron has been actively engaged in efforts to defeat
reimbursement claims across the country for close to a decade. He was on
the legal team in Sereboff v. Mid Atlantic Medical Services decided by the
U.S. Supreme Court in 2006. More recently Prof. Baron was involved in the
Wal Mart v. Shank litigation which resulted in a corporate reversal of
position at the executive level, permitting Mrs. Shank to retain her trust
fund and a revisal of policy by Wal Mart so as to cease reimbursement
efforts in all catastrophic injury situations involving Wal Mart
beneficiaries.
 

What the SCHIP Extension Act Means to Your Practice

On December 29, 2007, President Bush signed into law the Medicare, Medicaid, and State Children’s Health Insurance Program Extension Act (MMSEA). This Act makes changes to these three major health programs, as well as other federally funded services. Of particular importance to the plaintiff attorney, Section 111 adds new mandatory reporting requirements for group health plan arrangements and for liability insurance (including self insurance), no fault insurance and worker’s compensation plans.

Read Will Shapiro's article to learn more
Download MMSEA and MSA paper 10 28 08

Ethics opinion on lien resolution service as a disbursement against a settlement

The New York County Lawyers' Association Ethics Committee issued Ethics Opinion 739 addressing the issue of charging fees for outsourcing Medicare/Medicaid/Erisa lien resolution services as a disbursement against a settlement.

The opinion discusses the increasingly complicated nature of lien resolution, traditional handling of liens in personal injury cases, attorney liabilities and best practices when outsourcing.

Ethics Opinion 739 can be found on the NYCLA website at Ethics Opinion 739

468B Qualified Settlement Funds in single-plaintiff PI settlements

Thanks to John Campbell, Esq for the following article on the use of 468B Qualified Settlement
Funds in single-plaintiff PI settlements

"It is now common practice to structure all or part of a PI settlement with a qualified
annuity and a qualified assignment under I.R.C. § 130. Increasingly, settling plaintiffs
and their attorneys have expressed serious dissatisfaction with the traditional
arrangement in which the defendant has complete control over the purchase of the
annuity that will fund the qualified assignment.

In the context of PI settlements involving seriously or catastrophically injured plaintiffs,
a primary goal is to provide funds for the support and care of the plaintiff while
preserving eligibility for all available and appropriate governmental benefit
programs, including Supplemental Security Income (SSI) and Medicaid. For many years,
Special Needs Trusts have been commonly used to preserve SSI and Medicaid eligibility
for a settling plaintiff. Settling plaintiffs may require that the distribution of settlement
proceeds be delayed to allow time to complete planning for SSI or Medicaid eligibility.
At the same time, both the plaintiffs and defendants may wish to avoid delay in the
execution and completion of the settlement itself. Plaintiffs in this situation will need
a vehicle by which their settlements can be finalized without the proceeds being treated
as available resources during the time necessary to create and fund an exempt Special
Needs Trust. ..." continued at:  468B contnued

 

Medicare Secondary Payer Act

Medicare Secondary Payer Act

New CMS Contact Phone Numbers

Download cms_new_contact_list.pdf

CMS Consolidates Regional Offices

Thanks to MedAllocators for passing along the following information re consolidation at CMS.

The Centers for Medicare & Medicaid Services (CMS) has had ten regional offices throughout the country. Each office with jurisdiction over the Workers' Compensation Set-asides (WCMSA) created for cases pending in the states that the office oversees and issues the final, official WCMSA approval letter for all submitted WCMSAs.

This system has created some problems because each regional office could provide different information as to how a WCMSA was to be handled or processed.  Furthermore, some regional office staff were more reliable and provided a higher level of service than others.

On September 1 CMS consolidated the regions from ten to six. It is our understanding that six regions have absorbed the other four regions.  As with most major changes to an established system, we expect this to have a short term negative impact with, hopefully, a long term benefit.

Since this move came about abruptly, we suspect that the existing six regions are not going to be adequately staffed to deal with the increased WCMSA demands.

We expect there to be significant delays in the approval of WCMSAs. We had been recieving approval times ranging from 20 days to 90 days. With the changes we believe the approval time will run longer.  Hopefully we are mistaken, but CMS rarely runs as efficiently immediately after instituting a major process change.

We anticipate that it will take CMS from three to six months to staff the local regional offices to accommodate the change.  Once this accurs, it should make the process more uniform and efficient.

IMPACT ON LIABILITY CASES

As we had previously reported, the general liability MSAs were going to handled on a region to region basis.  Each regional office was going to be given the option to review and approve MSAs for liabilty cases.  Many of the regional offices that were going to review these types of cases have been eliminated. Therefore, there is much uncertainty surrounding the approval of general liability MSAs with the recent change. We will contact each office to determine if it is going to review general liabilty MSAs and pass this information to you when it becomes available.

Retainer Agreement Additions Regarding Governmental Benefits & Liens

SPELLING-OUT THE OBVIOUS

Retainer Agreement Additions Regarding Governmental Benefits & Liens

The intensifying focus on the collection of governmental liens and the tightening-of-the-belt in relation to public assistance, has created a more complex arena for the practice of personal injury. This has been magnified by the confusion and extra post-settlement labor created by the Ahlborn decision. While you understand and know what your retainer agreement states, now more than ever, it is important to make sure your retainer agreement “spells-out the obvious” i.e. limits your representation to the personal injury claim, allows the hiring of governmental and medical lien investigators, allows the retaining of additional attorneys to handle the lien resolution, and advise regarding impact of a verdict or settlement on public assistance. The below suggestions are to assist you in reviewing your fee agreement only. Of course, local bar rule should always be consulted.

LIEN INVESTAGATION COST:

I hereby authorize FIRM to take whatever legal steps it deems appropriate under the circumstances to prosecute my claim for damages, and authorize FIRM to advance on my behalf such reasonable costs and expenses as it believes to be reasonable, including but not limited to, expenses for hiring investigators, expert witnesses and/or attorneys (including attorney/experts to assist with investigating medical/governmental reimbursement liens).

DISBURSEMENT OF PROCEEDS

I understand that prior to disbursement of settlement or verdict proceeds, third-party interest such as Medicare, Medicaid, and other medical provider liens must be investigated and satisfied. I further understand that current state and federal law may require FIRM to take steps to determine if such interest exist, even if I have not received notice from medical providers prior to verdict or settlement. I understand that resolution of governmental and/or medical liens is a separate matter that may require the retention of additional attorney(s) or attorney firms under separate retainer.

INFORMING FIRM / PUBLIC ASSISTANCE

I understand that current and future public assistance, such as Medicaid, SSI, Food Stamps, subsidized housing, etc. may be affected by a verdict or settlement. I further understand that I am obligated to keep FIRM informed of any applications for such government benefits or changes in my current eligibility. Additionally, I understand that I must keep FIRM timely informed of all bills, liens and related correspondences from any health care provider or governmental agency. I understand that FIRM does not represent me in relation to applying for, obtaining or preserving governmental benefits. I understand that I must consider the impact on my current and future governmental assistance a verdict or settlement may have, and I should explore my options regarding preservation of these benefits before receiving a verdict or settlement. Failure to explore these issues before verdict or settlement may compromise my ability to do so in the future.

ldunnfox@helpwithliens.com

800-888-1743

HIPAA Compliant Medicaid Release Forms by State

Click for Hippa Compliant Medicaid Release Forms by State

ldunnfox@helpwithliens.com

800-888-1743

Wal-Mart Paid for Medical Bills & Then Sued for Money Back

JACKSON, Mo. -- A collision with a semi-trailer truck seven years ago left 52-year-old Deborah Shank permanently brain-damaged and in a wheelchair. Her husband, Jim, and three sons found a small source of solace: a $700,000 accident settlement from the trucking company involved. After legal fees and other expenses, the remaining $417,000 was put in a special trust. It was to be used for Mrs. Shank's care.

Instead, all of it is now slated to go to Mrs. Shank's former employer, Wal-Mart Stores Inc.

click here for the whole story

ldunnfox@helpwithliens.com

800-888-1743