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Birmingham Bar Association

Medicare Jennifer Pickett Medicare Is Getting ReAL When It Comes To Future Medicals In Injury Cases! Th is year, the Centers for Medicare and Medicaid Services (CMS) took steps toward enforcing the Medicare Secondary Payer (MSP) Act concerning future medicals. Eff ective October 1, 2017, Medicare Administrative Contractors will deny payment for items or services that should be paid from a Liability Medicare S e t - A s i d e (LMSA). Th e subject memorandum is directed to ...injured Medicare benefi ciaries ineligible... physicians and medical providers; however, attorneys need to take note because overlooking future medical issues will likely render injured Medicare benefi ciaries ineligible for injury-related care and may result in unpaid medical bills that are ultimately the responsibility of the plaintiff . Th e result may put attorneys at risk for potential legal malpractice claims. Defense attorneys are not outside the purview of this memorandum. All attorneys involved in a settlement need to take greater care when settling injury cases involving plaintiff s with a reasonable expectation of Medicare entitlement, and especially those currently receiving Medicare benefi ts. Moving forward, Medicare will not pay for those services related to the diagnostic code associated with the claim when the claim’s date of service is on or after the MSP eff ective date and on or before the MSP termination date. CMS has designated the following codes to be applied: N723 - patient must use Liability Set-Aside (LSA) funds to pay for the medical service or item; N724 - patient must use No-Fault Set-Aside (NFSA) funds to pay for the medical service or item. Medicare Administrative Contractors will be allowed to pay for injury-related care and treatment only in instances where “benefi ts are exhausted/terminated,” or not related to the injury claim. In order to avoid Medicare denying future medical payments, the plaintiff is going to be required to show the following: • Th e release did not shift the burden onto Medicare for future injury-related medical care and treatment; • Th e amount of the set-aside agreed upon by the parties was reasonable; • Th e settlement funds designated for future Medicare reimbursable care and treatment were properly exhausted. Again, it is critical for attorneys to ensure that the diagnostic codes that are being applied ...may result in unpaid medical bills... 16 Birmingham Bar Association


Birmingham Bar Association
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