Short Answer

If Medicare (through CMS) sends you a lien letter about your North Carolina injury claim, do not send money unless it is a formal Demand Letter. Most initial letters are Conditional Payment Letters that list Medicare-paid charges and often say not to pay yet. Review the charges, dispute any unrelated treatment, keep CMS updated, and after settlement pay the final Demand within the deadline (commonly 60 days) to avoid interest.

Understanding the Problem

You received a CMS letter about a Medicare lien tied to your North Carolina personal injury claim and it says not to send payment right now. You want to know what you must do next so the lien doesn’t delay your settlement or add interest or penalties.

Apply the Law

In North Carolina, Medicare has a right to be repaid for injury-related medical bills it paid once you recover money from a liable party. CMS (through its Benefits Coordination & Recovery Center) manages this under the Medicare Secondary Payer rules. Typically, CMS first issues a Conditional Payment Letter (informational; no payment yet). After you report the settlement, CMS issues a Demand Letter with the final amount and a payment due date. Disputes and waiver/compromise requests are allowed, and CMS generally reduces for a share of attorney’s fees and costs. State medical lien rules also affect how injury settlements are distributed, especially when other provider liens are in play.

Key Requirements

• Confirm and report: Make sure your claim is reported to CMS/BCRC and that your Medicare status and contact details are correct.
• Identify the letter type: Conditional Payment Letter (informational) vs. Demand Letter (payment required).
• Verify charges: Review diagnosis codes and invoices; dispute any treatment unrelated to your accident within the stated timeframe.
• Report settlement: After you settle, promptly report the settlement details so CMS can issue a final Demand.
• Pay on time: Pay CMS’s final Demand by the stated deadline (often 60 days) to avoid interest and collection action.

What the Statutes Say

• North Carolina Gen. Stat. § 44-49 (Medical provider lien notice) - Governs how medical providers assert liens against personal injury recoveries.
• North Carolina Gen. Stat. § 44-50 (Distribution of settlement with liens) - Sets distribution rules and caps for certain medical liens against recoveries.
• North Carolina Gen. Stat. § 28A-18-2 (Wrongful death damages) - Addresses allocation of wrongful death proceeds, including limited payment of medical and burial expenses.

Analysis

Apply the Rule to the Facts: Because your letter says not to send payment, it is likely a Conditional Payment Letter listing charges Medicare paid. Send your attorney a clear photo of the letter so they can review and dispute any unrelated charges. When your case settles, your attorney will report the settlement to CMS; CMS will then issue a Demand Letter, which you should pay by the deadline (often 60 days) to avoid interest.

Process & Timing

1. Who files: You or, more commonly, your injury attorney. Where: Centers for Medicare & Medicaid Services, Benefits Coordination & Recovery Center (BCRC) via the Medicare portal or by mail. What: Report the injury claim; request/review the Conditional Payment Letter; submit disputes on unrelated charges with medical records. When: Dispute promptly upon receipt; processing often takes several weeks.
2. After settlement, your attorney reports the settlement amount and fees to BCRC. CMS issues a final Demand Letter. Expect roughly 30–60 days for updated figures, though timeframes can vary by case volume.
3. Pay the final Demand by the deadline (commonly within 60 days of the Demand Letter). Your attorney typically pays CMS from settlement funds and documents the payoff for your file.

Exceptions & Pitfalls

• Wrong letter type: Don’t pay on a Conditional Payment Letter; wait for the Demand. Use the CPL to fix unrelated charges now.
• Medicare Advantage/Part D: If you’re on a Part C (Medicare Advantage) or Part D plan, you may get recovery letters from the plan, not CMS; processes and contacts differ.
• Interest risk: Ignoring a Demand Letter can trigger interest and collections. Calendar the due date immediately.
• State lien caps vs. Medicare: North Carolina medical lien caps apply to provider liens, but federal Medicare recovery generally takes priority; CMS typically reduces for attorney fees/costs rather than state caps.
• If the claim becomes wrongful death: North Carolina limits what medical/burial expenses can be paid from wrongful death proceeds and requires Clerk of Superior Court approval of such claims; that allocation can affect lien resolution.
• Documentation: When disputing charges, include claim numbers, dates of service, and medical records; incomplete submissions cause delays.

Talk to a Personal Injury Attorney

If you're dealing with a Medicare lien letter on your North Carolina injury claim, 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.