How can I resolve a Medicare lien before my injury settlement is paid?

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How can I resolve a Medicare lien before my injury settlement is paid? - North Carolina

Short Answer

Medicare has a legal right to be repaid from a personal injury settlement for any “conditional payments” it made for accident-related care. In North Carolina, you (or your attorney) should open a recovery case with Medicare, obtain and correct the conditional payment list, report the settlement, then pay Medicare’s Final Demand within 60 days to avoid interest. Do not send money until Medicare issues that Final Demand.

Understanding the Problem

You’re asking: in North Carolina, how do I clear a Medicare lien so my injury settlement can be paid? You received a Medicare letter that says not to send payment yet, and you have an active injury claim. You want to know what that notice means and the steps to resolve it before funds are disbursed.

Apply the Law

Under federal Medicare rules, when Medicare pays for accident-related treatment, it must be reimbursed from any liability settlement. In North Carolina practice, settlements usually aren’t disbursed until Medicare confirms the amount due. Medicare first issues a preliminary list of bills (often called a conditional payment letter). After you report the final settlement, Medicare issues a Final Demand, which must be paid within 60 days to avoid interest. If a case involves a minor, an incompetent person, or a wrongful death estate, a judge or the Clerk of Superior Court may need to approve the settlement and distributions, and lien resolution is addressed before funds are released.

Key Requirements

  • Identify and open the recovery case: Report the claim to Medicare’s Benefits Coordination & Recovery Center (BCRC) or via the MSPRP portal so Medicare compiles accident-related charges.
  • Review and dispute: Check the conditional payment summary and dispute any unrelated or duplicate charges before settlement.
  • Report settlement: After agreement, report the gross settlement amount and attorney’s fees/costs so Medicare can calculate the Final Demand (typically reduced for procurement costs).
  • Pay the Final Demand on time: You must pay within 60 days of the demand letter to avoid interest and delays.
  • Account for other plans: Resolve separate claims for Medicare Advantage (Part C) plans and Part D drug plans, which have their own recovery rights.
  • Court approval when required: If the settlement involves a minor, an incompetent, or a wrongful death estate, expect court oversight and proof of lien resolution before distribution.

What the Statutes Say

Analysis

Apply the Rule to the Facts: Your letter is likely Medicare’s initial notice that a recovery case is open and that you should not pay yet. The next step is to review the conditional payment list for unrelated charges, then report your final settlement so Medicare issues a Final Demand reflecting any allowed reduction for attorney’s fees and costs. Paying that Final Demand within 60 days will clear the Medicare claim and allow disbursement.

Process & Timing

  1. Who files: The injured person (through counsel). Where: Medicare’s BCRC via the Medicare Secondary Payer Recovery Portal (MSPRP). What: Open the recovery case, submit Proof of Representation/Consent to Release, and request the conditional payment summary. When: Early in the claim; update promptly when settlement is reached.
  2. Dispute unrelated charges on the conditional payment summary and report the final settlement amount, attorney’s fees, and costs. Medicare typically issues a Final Demand within a few weeks, but timelines can vary.
  3. Pay the Final Demand (online or by mail) and obtain confirmation of satisfaction. Provide proof to the insurer/settlement administrator so the net settlement can be disbursed.

Exceptions & Pitfalls

  • Medicare Advantage (Part C) and Part D claims are separate; resolve them in addition to traditional Medicare.
  • Do not assume North Carolina’s medical lien caps apply to Medicare—federal reimbursement rights preempt state limits.
  • If the injured person is a minor, incompetent, or it’s a wrongful death matter, expect court or Clerk approval and proof of lien resolution before distribution.
  • Submit proper Proof of Representation; without it, Medicare won’t discuss your file with counsel, causing delays.
  • Keep the conditional payment list current—new bills can post; request an updated amount before settlement.

Conclusion

To resolve a Medicare lien before your settlement is paid in North Carolina, open a recovery case with Medicare, verify and dispute any unrelated charges, report the settlement, and pay the Final Demand within 60 days. This clears Medicare’s claim so funds can be released. Next step: have your attorney use the MSPRP to obtain the conditional payment summary and, once you settle, request the Final Demand and pay it by the 60‑day deadline.

Talk to a Personal Injury Attorney

If you're dealing with a Medicare lien on an injury settlement, our firm has experienced attorneys who can help you understand your options and timelines. Call us today at [919-341-7055].

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.

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