I am not Lisa, however I did insurance billing for 30 years...as a Medicare Specialist.

Can you post the specifics without infringing the Privacy Act?

Was this a car accident? Workers Comp or Personal Injury?
Was Medicare the primary or 2ndary payor?

It was a slip and fall. Medicare was primary payor.
The rest of the accounts have been turned over to collection agencies (six different agencies). They *all* call every month to find out when they are gonna get their money. We can't release funds until we can work something out with Medicare. We've always had a difficult time with Medicare liens, but since everything started going through MSPRC, it's been IMPOSSIBLE to get any information from them or find a real, live, person who knows anything or has authority to do anything. I can't tell you how many letters I've sent to senators and congressmen expressing our frustration at their new "contractor". Clients can't get their money until the liens are paid. The case settled almost a YEAR ago! Do you know how upset they get at me because they know their money is sitting in our trust account and we can't release it until all outstanding liens are paid.

Sorry I went off on a little rant there. I'm probably going through this for about 1/4 of our clients now. Can you tell I'm frustrated beyond tears?

Oh I know your frustration! One of the reasons I left the medical billing field. Fighting to get the doctors paid got worse and worse. If it wasn't the red tape, it was the HMO's.

Do you work for an attorney?

If this was a slip/fall situation, was it at a residence? Or business? In those instances the home/business owners insurance should have paid first, then Medicare and finally their 2ndary if there was one. I rarely billed Medicare because the insurance always took care of the charges.

Is Medicare asking for a refund? If so, you can send the requested adjustment/refund check less any discrepancies (send validation for your short pay) certified to them....that should show the account/lien satisfied and then you can legally release any monies due your client.

At least that is how we handled the situation where I worked.

Sorry, I was so busy with clients yesterday I was to tired to get on here. E mail me with your phone and I will be happy to see if I can help. Maybe between the 3 of us Mombondo..if you dont mind?...We can get this worked out.

You guys are awesome. Lisa, I'll send you an email.

mombondo:

Do you work for an attorney? * Yes

If this was a slip/fall situation, was it at a residence? Or business? In those instances the home/business owners insurance should have paid first, then Medicare and finally their 2ndary if there was one. I rarely billed Medicare because the insurance always took care of the charges.
* It was a business. Owner's insurance doesn't pay up front. That would be an "admission of liability". Clients' health insurance (in this case Medicare) pays bills and we reimburse them when we settle the case.

Is Medicare asking for a refund? If so, you can send the requested adjustment/refund check less any discrepancies (send validation for your short pay) certified to them....that should show the account/lien satisfied and then you can legally release any monies due your client.
* Medicare does want there money refunded. However, there is only 25,000.00 and 54,000.00 in bills. In the old days (before MSPRC took over the Medicare contract for the government) we had a contact person we could call and he or she would work their little magic on some percentage program and let us know what they would accept as payment in full so as to at least give the other providers a percentage of amounts due and owing them too. No one is getting 100% of their money. There's only 25,000.00 to pay 54,000.00 in bills. The other providers (in this case, collection agencies for the doctors) have agreed to a reduction in the amounts they are owed. But we can't pay *anybody* until we work something out with Medicare. And MSPRC either totally fails to respond to our repeated requests to have someone contact us to discuss the matter or, if Scott does get somebody on the phone, they don't have the "authority" to reduce the lien and don't know/won't tell us who DOES have authority to do it.
I don't know if any of that made sense. I'm just frazzled today. *sigh*

OMG....I am so glad I am out of Medical!!!

I would be glad to put my input into the conversation.

Were the providers Medicare participating? If so, the fee schedule determines the charges/payment.

Did this client have a 2ndary? If so, they should have picked up the 20% after the Medicare payment...thus other than the deductibles, services/charges were paid in full!
Everything else would be a "write off/provider adjustment".

I can email you both my phone number and we can talk.

I live in Nevada and work Tuesday-Saturday.