Colorado Accident & Injury Law Part III cont. Medicare & Medicaid Liens
1. The Medicare, Medicaid and SCHIP Extension Act of 2007 (“MMSEA”).
- Requires defendants to report certain information regarding settlements with Medicare beneficiaries to the Secretary of Health and Human Services.
- The Centers for Medicare and Medicare Services (CMS) have not provided guidance on when a Medicare Set-Aside (MSA) is required.
- There is presently confusion on the part of insurance companies that an MSA is required whenever there has been Medicare payment for medical bills in a settlement of a personal injury case.
- Some insurance companies and some consulting companies have taken the position that an MSA is required in every such case. This is not the state of the law.
2. Prompt notification to Medicare advised:
- If Plaintiffs’ counsel does not proactively notify Medicare and inform them of the amount of the Medicare related bills, it may face confusion and substantial delay if the insurance company later mistakenly informs CMS of the amount of such bills.
- Medicare should be notified by mail.
- Part A Medicare portion and Part B (private insurance portion of bills) need to be identified.
- Medicare requires that medical providers and hospitals bill any third party insurance company before Medicare will pay.
E. Medical provider balance billing:
- Hospitals and medical providers cannot balance bill if Medicare has paid.
- It is a hospital’s duty to identify whether or not Medicare or Medicaid is available.
F. Seeking assistance of a specialist to identify future need:
- The best advice to any Plaintiffs’ attorney settling a large case, probably over $700,000, is to seek the assistance of a specialist who will be able to identify the future needs of the client and provide a detailed opinion of what those expenses will be for and what the amount will likely be.