Medicare Liens: Obtaining and Appealing Medicare Final Demands; Navigating the Five Levels of Medicare Appeals
Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
Intermediate
- work Practice Area
Personal Injury and Med Mal
- event Date
Wednesday, August 7, 2024
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
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This CLE course will provide personal injury counsel for both plaintiffs and defendants, as well as adjusters, with practical tips and considerations for obtaining a final demand using the Medicare portal and for appealing a post-final demand.
Mr. Cattie focuses his law practice exclusively on MSP and MSA issues, providing legal opinions regarding reporting and repayment obligations as well as assessing a client’s future medical exposure under the MSP Act. In the MSA area, he has personally reviewed or overseen the review of over 10,000 distinct fact patterns. Federal and state court opinions such as Smith v. Marine Terminals of Arkansas, Tye v. Upper Valley Medical Center, and Doe v. Company X cite his analysis favorably.
Mr. Place exclusively assists personal injury victims and plaintiff counsel with complex lien resolution problems using his vast knowledge of the other side’s techniques. He spent fourteen years representing large private group health insurance plans, self-funded ERISA groups, FEHBA plans, Medicare Advantage plans, state Medicaid plans, as well as stop-loss and disability plans in their subrogation/recovery programs. Mr. Place asserted subrogation/reimbursement rights for those groups in all fifty states, personally recovering nearly one hundred million dollars for the insurance industry.
When personal injury plaintiffs accept Medicare benefits to cover accident-related bills, they are obligated to pay back the government if a third party later takes responsibility for causing the underlying injuries, as demonstrated by a settlement, judgment, or another award. Medicare is usually entitled to reimbursement of their expenditures on accident-related medical care.
The Medicare beneficiary must first obtain a "final demand" using the Medicare "Portal." The panel will review this complicated and confusing process and offer tips for navigating it correctly. The final demand can be challenged through an appeals process.
The Medicare appeals process is a multi-step course entered into once Medicare has issued its final demand or amount owed to the Medicare program. The process is different for different Medicare Parts and has five different levels culminating at district court. Each level has strict time limits, forms, and processes. Failure at any level cuts off further review.
Listen as this esteemed panel guides counsel through how to use the Medicare Portal correctly and then through the appeals process.
- Using the Medicare Portal
- Appeals
- Redeterminations by a Medicare Administrative Contractor
- Reconsiderations by a Qualified Independent Contractor
- ALJ appeals to the Office of Medicare Hearings and Appeals
- Medicare Appeals Council appeals
- District court
The panel will review these and other pivotal issues:
- When using the Medicare Portal, what mistakes cannot be corrected?
- What are the most common types of mistakes Medicare makes when issuing a final demand?
- Is the Portal form and AI driven?
- What types of appeals are most likely to succeed?
- How soon should appeals be made?
- Who decides appeals?
