Memo to Physicians Treating Personal Injury Patients Who Are Medicare Eligible

You are probably treating at least one personal injury patient under an attorney lien, auto med pay, premises med pay or health insurance, who is also Medicare eligible. Or, you may be treating a personal injury patient that you are billing Medicare directly for your services.

From the beginning of a personal injury claim, you should always inquire into a personal injury patient’s Medicare status.

Medicare eligibility applies to persons over 65 years or age.  Or, it can  apply to disabled individuals who are under 65.

For any victim of a  personal injury accident who is Medicare eligible, the attorney is burdened by complying with the Medicare reporting requirements, which are very cumbersome and time consuming.

Furthermore, the attorney must comply with the Liability Medicare Set-Aside Arrangements (LMSA).  A Set-Aside must be done whenever a patient making a personal injury claim will be seeking future medical treatment that will be covered by Medicare. This is another cumbersome, time consuming, and sometimes expensive, procedure.

Where the beneficiary’s treating physician certifies in writing that treatment for the alleged injury related to the liability insurance settlement has been completed as of he date of the settlement, and that future medical items and/or services for that injury will not be required, Medicare considers its interests, with respect to future medicals for the particular settlement satisfied. Please see the Centers for Medicare and Medicaid Services September 30, 2011 Memorandum .  If the beneficiary receives additional settlements related to the underlying injury or illness, the attorney must obtain a separate physician certification for those additional settlements.

The physician certification obviates the need to for the attorney to submit for a LMSA.  Such certifications by treating physicians are of tremendous assistance to the patients and their attorneys who are pursuing the third-party claim against the person who caused the personal injury accident.

Please help us by placing, where appropriate, a written certification that no future treatment is expected in your discharge note, discharge summary or final report to the attorney.  As you already may know, time delays associated with a obtaining a settlement draft from an insurance company on a Medicare claim can often be months or even years. If you make this change as a part of  records procedure, this can assist us in getting your bill paid in a more timely manner, and will result in a quicker  distribution of settlement proceeds to your patient.

This entry was posted on Thursday, September 13th, 2012 at 1:09 pm and is filed under auto accidents, bodily injury, Medicare, personal injury, personal injury attorney, Settlements. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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