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Tips for Handling a Medicare Lien without an Attorney


How to Handle a Medicare Lien without an Attorney

If you receive Medicare benefits and have been injured in an accident, Medicare likely has a lien on any settlement or award proceeds you may receive. In other words, if you are injured in an accident and Medicare covers any part of your medical expenses, the government will have an interest (lien) on your settlement or award. Medicare has strict procedures that must be followed to handle a Medicare lien.

Seven Steps to Help Challenge a Medicare Lien

Failing to pay a Medicare lien can result in fines and loss of coverage. This article provides a general guide on handling your Medicare lien to prevent such penalties following your Durham personal injury accident.

Step 1: Report your case to the Coordination of Benefits (COB): After you have been injured in an accident and have received medical treatment paid for by Medicare, you will want to contact the COB office at 1-800-999-1118 to inform them of the pending settlement of your Durham personal injury claim. You should have the following information available: Medicare Number (HIC number), date of the accident, injuries sustained (detailed), as well as the insurance provider of the at-fault party. Make sure to give as much detail about your case as possible. Moreover, give detailed descriptions of the injuries sustained in the accident, as Medicare will use this description to help determine their lien amount. Also, the earlier you contact the COB office, the better, as handling a Medicare lien can be a lengthy process.

Step 2: Wait to Receive your Rights and Responsibility Letter and Beneficiary Information Questionnaire: After contacting the COB office, they will review the case and move it over to Medicare Secondary Payer Recovery Contractor (MSPRC), another Medicare department. A Rights and Responsibilities letter will be sent out along with a Beneficiary Information Questionnaire. The Beneficiary Information Questionnaire must only be filled out and returned if your personal information has changed. The Rights and Responsibilities Letter does not require a response. The letter will include information on the Conditional Payment Letter (initial lien). The letter establishes that Medicare is aware of your case and is processing the initial lien amount. Essentially, the letter begins a 65-day countdown to when MSPRC will send out the Conditional Payment Letter.

Step 3: Constantly Check the Status of Your Conditional Payment Letter: Once you have received a copy of the Rights and Responsibilities Letter, Medicare has 65 days to send your Conditional Payment letter, which includes the lien amount. Medicare can be very slow when sending correspondence, so the letter may take some time. You should contact MSPRC several times to check on the status of your Conditional Payment Letter. You can call MSPRC at 1-855-798-2627. When you call, have your Health Insurance ID Number handy.

Step 4: Review the Conditional Payment Letter and Dispute Unrelated Charges: Hopefully, you will receive your Conditional Payment Letter within the 65 days. The letter will include a medical payment itemization that will break down what medical treatments are included in the lien. This information will be found in the ICD-10 code section of the letter. You will want to review these charges and dispute any treatment you feel is unrelated to your accident. If you do not understand what an ICD-10 code stands for, please use the embedded link to visit the published code site.

Also, be sure to check the dates of the charges of your Medicare claims, as they may be before or far after your accident; thus, these charges should not be included in the lien amount as they likely do not relate to your accident. Be thorough when looking for unrelated charges, as they are common and will cause the lien to be too high if not disputed.

Step 5: Dispute Any Unrelated Charges, if Applicable: Once you have thoroughly reviewed your Conditional Payment Letter, you should dispute any unrelated charges. The MSPRC requires you to do so in writing or online on the Medicare site. To dispute in writing, you should include a letter to MSPRC with the large heading “Disputing Conditional Payment.” Also, include your name, Medicare Number, and accident date. You will then want to include a copy of the Conditional Payment Letter with a line marking through each unrelated claim. You should also include detailed information about why the claim is unrelated and any records you may have to support your dispute.

The MSPRC will take about 60-90 days to respond to your disputed claims. You will receive their response in the same form as the previous Conditional Payment Letter. MSPRC will not provide any reason for granting or denying your disputed charges; however, MSPRC may request more information before they make a final determination in your case.

Step 6: Request a Final Demand Letter and Pay the Final Lien Demand Amount: Once your case has been settled or you have received an award, you should request a final demand letter. You can do so by simply filling out the “Final Settlement Detail Document,” which would be included within your Conditional Payment Letter.

Please note that it’s important that you do not fill out your “Final Settlement Detail Document” until you have disputed all unrelated charges and have received a response satisfactory to you. If done out of order, you could be responsible for paying funds that are not related or charged interest while awaiting an adequate response. You will want to fill out all the information requested on the document and mail it to the address provided on the form. This document can also be uploaded to the online portal at

Once MSPRC has received and processed your request, they will send you a Final Lien Demand Letter. This will be the amount you must pay to Medicare from your settlement or award proceeds. You will want to pay the final lien demand amount within 60 days, or interest will begin to accrue. Please be aware that even if you plan to appeal the Final Lien Demand, you should still pay the amount within 60 days to avoid interest charges. You will be refunded overpaid money if you are to win your appeal.

Step 7: Appeal Final Lien Demand: Once you have received your Final Lien Demand and have paid the amount, you can still appeal the Final Lien Demand because unrelated charges were still included in the lien. You must appeal within 120 days of receiving the Final Lien Demand Letter, and you should do so by following Step 5 above; however, be sure to change your letter heading to “Dispute of Final Lien Demand.”

An Important Reminder from the Wallace Pierce Law Team

Disputing the lien balance before submitting your “Final Settlement Detail Document” can help eliminate having to appeal the final lien demand. In other words, appealing your lien amount early can help eliminate Step 7 of the process. As you can tell, handling Medicare liens accurately and effectively can be quite daunting, and if done incorrectly, you could lose benefits or be personally held responsible for what’s owed. We recommend contacting an experienced personal injury attorney to handle and navigate the complexities. Wallace Pierce Law is just a call away at (919) 887-7892. We can review your case and help you navigate the Medicare lien process confidently.