Conditional Payment Liens are payments made by Medicare for medical treatment where a primary payer (insurer or self-insurer) has or may have an obligation to make the payment but may have not paid for the treatment. The Medicare Secondary Payer statute requires resolution of these conditional liens prior to settlement. Severe penalties may be imposed if the primary responsible payer does not address and resolve these liens.
föra cost containment is experienced in obtaining the conditional payment “Lien” detail, reviewing information provided by CMS for accuracy, and negotiating discrepancies on your behalf. There are numerous factors, such as causal relationships, pre-existing conditions, and duplication of payments that can come into play. Our team of experts ensure accurate and timely resolution of your liens with our Conditional Payment Lien Resolution Service.
In each case,
föra cost containment will:
- * Verify if the claimant is eligible or already receiving government benefits
- * Determine the settling parties’ obligation to notify healthcare plans
- * Assess the healthcare plans’ right of recovery
- * Audit and analyze all reimbursement claims to determine accuracy and to “carve out” items unrelated to injury/settlement
- * Pursue relevant administrative remedies, such as damage allocation, waiver, and compromises to ensure the appropriate “net” recovery for the claimant
- * Handle other healthcare issues related to settlement. We offer specialized Medicare Set Aside (MSA) and MSA Custodial Account Services.
If the claimant is a Medicare beneficiary we will initiate a lien search to ensure Medicare has not made any conditional payments that would otherwise be covered by claim. If such a lien does exist, we can resolve the lien with Medicare. All Medicare liens must be settled in addition to the cost of the MSA. If the case has been reported by a settling party, an automated process begins whereby the Conditional Payment Letter is automatically generated to the reporting party and the Medicare beneficiary. Initiating a second search would be unnecessary and could delay the overall process.