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Medicare: A Personal Injury Problem Gets Worse

I’ve written before about my frustrations in dealing with Medicare.

When our clients have Medicare, we have to contact Medicare, find out the amounts they paid, and then negotiate reimbursements with them.  This is a painstaking process that involves several steps.

First, we notify Medicare that our clients are asserting personal injury claims.

Second, the MSPRC (a division of Medicare) issues a Rights and Responsibilities letter. 

Third, MSPRC starts searching Medicare claims to find claims it filed relating to our clients’ personal injury suits.

Fourth, Medicare sends a Conditional Payment Letter that identifies the claims it believes that it paid that relate to our clients’ injury claims  (in other words, it excludes payments for any care that isn’t related to the clients’ injury claims).  This letter is supposed to come within 65 days of the issuance of the Rights and Responsibilities letter.  Often, it takes longer. 

Fifth, we may have to go back and forth with Medicare asking them to remove any charges that we think are unrelated to our clients’ claims.

Sixth, we settle the case and send Medicare information regarding the settlement.

Seventy, Medicare takes that information and uses a formula to come up with a final number it believes it is due, and it issues a Demand Letter for that amount. 

 At best, it takes 6 weeks to a couple of months.  In some cases, it can take much longer. 

Today, I was looking at the MSPRC website for a form, and I come across this news:

Alert: Issuance of the Rights and Responsibilities (RAR) and Demand letters has been temporarily suspended

Issuance of the Rights and Responsibilities (“RAR”) and Demand letters has been temporarily suspended while these letters are under review. The MSPRC is still working cases, and the RAR and Demand letters will be mailed out once appropriate revisions have been made.

So as of now, Medicare has stopped the process, and it doesn’t appear that there is a way to resolve future cases.  I’m not sure how long this has been posted on their website, and I’m not sure how long it will last.  But rest assured, it will only make an already time-consuming process worse.

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- Sara Hickman