Send Beneficiary Conditional with airSlate SignNow

Send beneficiary conditional

hello everyone and welcome to synergies third Thursday a webinar presentation we're here today was Dave place and he's going to talk to us about Medicare conditional payments before we get started I just want to point out several things in your control panel as you can see you have a section for questions and a section for handouts that's over there on the right side of your screen the handout is a PDF of David's presentation today so you guys can click and download that unless it helps you to follow along also if you have a question throughout the presentation just type it into the questions field and what we'll do is address it after the presentation via email so just hang tight and we'll send your response as soon as possible with that I'm going to turn it over to Dave thank you everyone for being here today I appreciate you spending your lunch with us to learn about Medicare hopefully you have something delicious in a few and some coffee to keep you awake I'll try to make it as interesting as possible we're going to walk through how Medicare the instrument works some optional processes that are available will help you a lot in your practice as well as how to get Medicare refunds and we'll briefly talk about Medicare Advantage plans because I'm sure that's a very fast changing areas of law right now and of great concern to the trial attorneys who are having to deal with that change a little background on who I am I took over the head of synergies lien resolution group about five years ago before that I spent 15 years as a recovery attorney the law firm I worked I was Gibson and sharp things now Gibson cold aquion was the company where a captive law firm we worked for formerly trover for many healthcare recoveries so Rawlings optimal dose who for my people for a long time I simply couldn't look in the mirror anymore so I switch side so now we do everything for plaintiffs only so everything we're talk about is from the plaintiffs perspective so if you have any questions please put those in the in box we'll make sure to get those addressed Medicare concerns will be complicated if it is anything else okay Medicare conditional payments first of all Medicare makes payments conditionally Medicare the act is actually a Medicare secondary payer Act so it's important remember that Medicare is always secondary there's one unique circumstance I'm calling TRICARE but Medicare is always secondary so they're looking for reasons not to pay if they have made a payment they only pay it conditionally the condition being that if any point in the future another quote primary plan becomes responsible for bills or services Medicare is already provided then Medicare needs to be repaid it's important to understand that this is operating from the Medicare trust is running out of money that's where Medicare set-asides are out there and that's why they're taking such a more aggressive stances in recovering conditional payments simply because Medicare is out of money so how to handle these in your case I mean I've lot of attorneys um we were based in Florida with a lot of attorneys you're representing a lot of Medicare beneficiaries well the first thing you want to do on when a client walks in your office is on Medicare is have them sign these two forms proof representation and the consent to release now the proof representations of form is making sure that Medicare is aware that you're a attorney and they consent to release it's just a HIPAA form here's the forms they use consent to release now that Medicare will accept your own hip authorization if your client signs women they take on you take on representation just make sure all the names match I'm they get very confused with anything that's off perfection to make sure everything your addresses and your name your law firms match your documents then your report your case you work your case the BCR see the benefits coordination center those you practicing for a while remember MS PRC which was the former contractor for Medicare all these people do is collect unconditional payments you can report several ways you can call it in you can fax it in you can mail it it we send everything in via fax or via the portal which is a credibly useful tool if you're not already using the Medicare secondary payer recovery portal in your office I had a recommend getting it I say that and so you may have tried and run just a quite complicated process to get that portal set up is because Medicare operates I guess 1963 and they'll have to mail you your password as one of the steps in the process I do recommend using it I'll go a few things in this prompt in this position day but it's benefits but for your office really it's a big productivity enhancement for your office it'll save your office a lot of time the fun with Medicare and a lot of attorneys use a workaround of going on to Medicare and logging in as though there's a beneficiary that's certainly works and in practice a while but it's cumbersome and using the portal itself will speed up this practice in your office then you're reporting the case to Medicare you need to give them everything about the beneficiary everything about your case and everything about yourself in particular I want to focus on what is their descriptions of alleged injury or illness or harm they're going to be as specific as possible in your important injury for instance you don't want to say back you want to say l4 l5 you don't want to say arm you know say left arm or or broken tibia or whatever you want to um you know to be specific as possible and I say that because Medicare is going to add every single charge from the date of the incident forward unless they're really on their game which is rare or you've given them some guidance now even if you're as specific as possible in identifying the injury they're still going to mess it up but it's a little like defensive driving you can only control what you can control so exert as much control as possible we do understand it make like I still do things wrong on the example I always I always use a funny example with a true example someone reported a broken arm to Medicare and they added a hysterectomy in the claim summary has a pretty bad broken arm it takes a hysterectomy to get it fixed but that's nothing's Medicare does so as on is on you to watch that again here's the Medicare secondary payer recovery portal this is what it looks like when you set it up these are just click these buttons as it this starts the process to build you access to the portal that does require a little delay because things come in the mail to you you can report things on the portal I highly recommend using the portal now after you've reported the case to Medicare they'll respond in about 14 days with what's called um the rights responsibilities letter this looks like a questionnaire I just got went today clients often get these and confused of what they are there's many of your asking for disinformation religious confirming they've opened a file if you have addition formation use that form to return it to them from this point forward you're going to make sure you use the correspondence cover sheet that's what it looks like it is simply a fax cover sheet but if you don't use this Medicare is not paying attention anything you send them I envision the the Indiana Jones your closing scenes in the original movie where the pushing the big warehouse on big box of the warehouse um the government no ones are looking those boxes I imagine those boxes are full of letters to Medicare without the cover sheet so make sure you using the cover sheet a couple of things don't use highlighters Medicare scans things that's not going to pop up and then these may seem like small things but those you deal with medical regular basis understand they're looking to not do work so Amy's they can do to avoid work they will and they don't tell you in some simple errors in made so you may have sent something off to Medicare without the cover sheet no one's going to call you and tell you that you're simply going I think Medicare is doing something and three months later you realize they're not so so it's important that you don't miss any of these and you're dotting the I crossing the T kind of situations now sixty-five days after the race responsibility letters sent out you'll get your first conditional payment summary this is ninety days after you poured in the case to Medicare nothing is going to speed this up sanity does is all day every day we can't speed this up there's one little trick we can do maybe save you 30 days on this that's only the case has been settled and you give up some of your audit abilities so it's going to take about three months before you get your first conditional payment so typically three to four months from beginning to end is going to be the fastest way you can get things done with Medicare so you're going to want to start early in your case so you don't delay at the end now when you get their rights responsible make sure you use your first conditional payment summary the first thing we always do when I recommend you do is audit it said Medicare's love saying errors in there so your check your provider names the diagnosis codes the dates the charge amounts those kind of things for example we've seen things on to claim somewhere like unspecified pain but doesn't say that diagnosis code that is using icd-9 code then once you translate says unspecified pain well you're serving with dispute that I have unspecified pain sitting here right now it's not related any trauma code it's ready to be being 46 so dispute those kind of charges you're going to want to make sure you have a clean summaries clean as possible the nice mess dispute process is there's no limit you can dispute a thousand times again don't use a highlighter you ever be specific as possible well when I started in synergy I would I brought what I thought was more like clever ideas to speed this process up we built worksheets for Medicare we took um color we did color code things not how to color code things for them they didn't like they like it simple simple simple so you're gonna want to dispute on the portal of possible well we've have a slide showing yes this is what of dispute looks like on the portal a list of the claims and you simply click the button on the left to dispute them and submit your dispute if you're doing it in writing which I'm not against you in writing that's a good way to do it you're going to use the actual claim summary Medicare sent to you we Larry circle the ones that are acceptable but draw X's through ones we're disputing and put a simple legend on the front of the claim summer saying X is bad the circle is accepted it's again it sounds unprofessional but that is frankly the way Medicare likes it I think they take it and crayon if we could do it in crayon for him so that's an important process not to be looked over and not to be shortchanged this is something we will work closely with your office even working with you to make sure that we're getting the claims you know there are only the claims are being claimed as in by accident or on the claim summary okay so this is how we're chopped right now is what's ongoing while your litigation is progressing you're managing life force interaction at the same time you manage the conditional payments now there's an OP process which I'm gonna spend a lot more time going into this because most trial attorneys are unaware this process is even out there and it's probably the most useful process available for Medicare so one thing I don't make fun of them for not much anyway last January 2016 they put into place a new functionality on the portal why I tease it a little bit was supposed to be in place in September 2014 and said a little bit behind but what it does it allows for what's called the final conditional payment process and there's some it's a pretty as we've met all things Medicare some pretty narrow windows but it's a very useful tool and so I'll walk you through it essentially if you have an anticipation that your case is going to resolve in the next 120 days the mediation or settlement conference or you're just at that point where you know it's coming up on the Porter you click a little button to put you into the final conditional payment process now this has to be a case audience be set up with Medicare so you've already done the original work you're now on the portal you click that little button it does two important things I guess wait think about it or think of it as like or not like a rocket docket but if you fall out of this process there's no negative impact to your case or your relation with Medicare this is just a way to speed the process up okay the two things it allows you to do is a speeds up the dispute process and the most importantly it allows you to get a final conditional payment amount before mediation so you can walk into mediation or settlement conference knowing the amount view back to Medicare now I'm sure some of you have had horror stories of having additional payment amount be one number through the litigation when you request to final demand it comes back in a grossly exaggerated number that happen this is why this process was developed because I was happening so often trial attorneys simply had no idea no ability to tell their client mediation what they're going to net because they had no number for Medicare so the process works like this you're in 120 day window you clicked the button you're in the sped up process now you can see hilly join this process one time you know one time shot at this field information out clickable buttons to go through the process with the portal and actually Medicare has a great flow chart right here on how it works so you're in the hundred twenty a process you now need to dispute some charges so on the poor you see a lot of unrelated charges in this sped up process you're only allowed one dispute I said before you speeds and times while on this process you only get one shot at it no reason for it is Medicare needs to respond to that dispute within eleven days if they don't respond eleven days then it's like a request for admission your dispute is just granted they missed a deadline it's granted now there's an exception but the exception is limited to Medicare is allowed to extend beyond eleven days in less than one percent of their cases on total cases so don't expect that expect them to if they don't respond to days SP will be granted okay now the second process involves the mediation date itself with if you download I believe we have a picture that downward yes if you download the final conditional payment amount from the portal make sure they give a pixel yeah a letter like this um and tells the day a download if you settle the case within three days of that download is the final conditional payment amount it will not change now the final conditional payment amount is the final conditional payment amount it is not the final demand the final demand is a constraint amount reduced by procurement cost which are your fees and attorney and cost so you can do the calculation yourself and I'll give you the form of a minute but this 5-8 amount isn't the amount you owe Medicare that amount will still be reduced by your fees and cost but this letter is helpful in a lot of ways one it is is you seize on CMS letterhead it talks about the finality of it so this letter should be accepted by defense counsel as the final letter a lot of you getting settlements held up these are ruling for the final demand this is that letter so you have it at mediation you can put it right there let the fence carrier take it home because all the dates right there when someone has to take place and when when if you have to inform Medicare of the settlement you have 30 days after it is download to notify Medicare the settlement again the settlement date means was in three days of the download these have to notify Medicare within 30 days not make payment notify medical in 30 days of that and work to lock this number in again with in debt numbers read by procurement cost you know that's a it's a very helpful tool with your mediation so you tell your client here's the net but the only way you get this letter is being that sped up process now if we can do this almost instantly if you have a case right now that's set up on Medicare so that we can't set up Medicare that fast but soon as already said on the portal which every case on the portal and set up with Medicare and you call me after this after this presentation say Dave I gotta meet tomorrow I'm yes we have the center gestation so they allow us to do it but assuming we have efficient and with Medicare it is just a click of these buttons to get this letter so it's very helpful that for that process again this is kind of what the portal looks like as you can see this case information here you're able to get this information we're able to get it for you without any authorization we get a screenshot of this screen without authorization for Medicare in order for us to do this or in which this guy's access at a portal all you need is the date of birth the date of loss the plaintiffs last name and their social security number you can pull a scrim just like there and it was nice about this screen that tells you the status that this case is currently in demand it tells you the conditional payment amount and the final demand amount as well as the date the letter was sent that's great information because often times no contact of our clients who simply are unable to get any information or Medicare and they're operating in the dark if you're a case like that shoot Susan Ryan email with that bit of information very quickly get this screen shot back we can't see any more information than this we need a screen shot like this so you have some information for your file okay the final settlement detailed document this is when you've settled the case and now it's time to tell Medicare about the settlement copy right here very straightforward document like the portal the portal it's the same way but all acids these simple things matter settlement was there a no-fault paid this means no-fault paid to your client not no-fault the paid bills no pulse is paid to your client you matter your fees and matter your cost and the data cell you send off to Medicare again you do it on the portal Medicare will take about 21 45 days to send you the final demand letter then once you get that final demand you have 60 days to make payment but how many the calculations talked about earlier have Medicare determines the final demand amount is based upon your settlement relative to the amount of the Medicare conditional payments the breaking point is if the Medicare conditional payments are larger than your settlement then you'll get your fees and cost Medicare take all the rest means a plaintiff gets zero I tell our clients that every single day it's unfortunate it's the way that regulation works I'll talk about a way to fix it but that is a reality and there is no way around that if Medicare has paid less than the settlement or judgment the Medicare does erase you essentially reducing my fees and a pro rata share of cost there's the actual formula there but um lawyer math and divided by three innocence but she sure it get out of me but that is the ratio you plug numbers right in and that's exactly the math you do to determine the Medicare demand amount oh this is what you'll do is if you're sitting in mediation you have the final conditional payment letter you'll plug that number right in there and do this exact formula you know the exact amount this do Medicare down to the penny one note on the the documentation needed now often ninety-eight percent of the time the only information is into Medicare regarding settlement is that document now if you have a lot of costs so that costs and fees you know equal over forty percent of the settlement Medicare is likely to ask for confirmation of the cost typically a closing statement even a draft closing claim but they don't need receipt turning like that base when a closing statement some evidence to back up those costs now you must pay this demands in 60 days that's a hard deadline on a 60 first day Medicare start adding interest it's gone down a little bit now at one point was near 12% I think it's now a little over 10% nothing tolls that not if you file an appeal now if you ask your waiver not to explore it compromise it adds to the principle and then we start making payments just like it's a bad car loan the payments going into interest first before they go the principle now if you have you pay Medicare you the final demand you make payment Medicare will send you a letter saying we received your check they'll give you a check number the amount of check and they'll say their file is closed does that is what you're after that's your good a jail free card well not necessarily free but that's your that is make sure you satisfied obligation to Medicare you have no exposure and your client has no exposure you're done at that point you were done with your responsibility Medicare you've addressed that can equal payment you have no exposure to yourself your firm or your client you can close your case now if there's a problem with the file demand and sometimes meaning a lot of times there can be Medicare may riad unrelated care that it previously took out they may be the numbers wrong and simply miss appointments apply the statute with situations where defense counsel reports the settlement before time discounsel does so Medicare issue something called a conditional payment notice on the cancer treatment notice is an interim letter between the show payment letter and the final demand essentially means they were talking about a settlement or what hook you think you know I have any information regarding fees or cost so their entire control pain amount is the final demand and that letter says within 30 days and you tell us about attorneys fees cost or any dispute or the final demand will be the conditional payment amount that letters often sits as beneficiary not to you and beneficiaries don't like sharing this like for some reason so often you'll you may when that situation arises there's a problem in Medicare super has introduced by fees and cost the way to solve that is via the appeal route appeals are only useful for two things either the inclusion of unrelated care in the final domain claims summary or the misapplication reduction statute nothing else goes in the appeals now for synergy you know I'm an attorney sanity is not a law firm I'm not practicing now but we've done the first two level appeals for our clients included in our service because their paper appeals the first level I'll go more to these in a second actually I click the slide they go back the first appeal is a redetermination this is done by internal unit but a separate unit inside BC RC which is the contractor the second level is reconsideration which is done by an external unit it was called a queue I see a qualified independent contractor for the in the Southeast region it's maximus federal services they do an outside review of those appeals now the third level appeal we cannot do that it requires an appearance before an ALJ but I also say it's decision making time anyway at that point because according to the CMS website it takes 28 weeks get on the docket and expect a 28 28 month delay if we get a hearing so that's awful long time to wait I always say we're talking about you know elderly injured people and waiting over two years is completely unreasonable so we'll talk about so many other options let me go back a little bit the post final demand there are four things you can do to try to reduce or we call to get a refund back from Medicare of what was paid to satisfy the final demand now we're pretty good at doing this we developed this service as a way to answer the question that our clients are asking us I'll tell you the war story I was talking one of our great attorneys in Virginia is a date I settled the case but under the regulations I get my fees and cost and my client gets nothing I can't live with that as an attorney we hear all kinds of bad things about ourselves but we also the truth we all were in the business of helping people but they said it on TV or not so most attorneys really sticks in their throat that the injury victims getting nothing but they're getting their fees at cost so this question was Dave I'm just going to cut my fee and give 10 grand in my client so she gets something out of this well unfortunately Medicare because there's that Medicare fraud because the reduction their payment statute to Medicare or based upon fees actually paid so if you reduce your fee the benefit that reduction goes to Medicare not a result anybody wants to have so you're going to catch-22 so that's where we synergy developed the service where we go back to Medicare post final demand and use some pretty unique statutes and regulations to try to get all or some of that money back now our success rate used to be about 80 percent now it's about 73 percent we're trying things more under fringes a little more expanding I'll talk about the options but how we do that but we've gotten back you know in some projection needs to be updated about three and a half million dollars they started doing this back in 2013 and our average reduction the best refunds about $30,000 now I know you probably feel like I'm selling you a ShamWow like what is this refund he's talking about in fact we have competitors writing blog saying don't believe anybody says you a refund from Medicare it doesn't happen it really does in fact the reasoning of a copy would check on this marketing piece is for the exact reason a real check fifty thousand dollars back from VC RS it oh if it appeals always the first thing we look into but is it their limited use because it only uses two circuits I've talked about so after that we move on to the waiver or compromise options there's two guides of waivers and one compromise so is this a little bit in detail here the first is a financial hardship waiver this is under eighteen seventy C of the Security Act this is based completely on your clients finances I'm Bill Gates is never getting this waiver but it's not based upon the settlement itself I'll tell you were storing a second on that but the idea is that if it creates an undue hardship to repay Medicare Medicare will consider a full or partial waiver they look at fact remember the slide says that here we go the standard is virtually no recovery if it defeats the purpose is chapter and the purpose of the chapter is to provide benefits to most needed most I most susceptible to injury in danger and falling through the cracks members of society that's why we have Medicare Social Security is to is to be a benefit to the citizens so if it's defeating that purpose is just being the purpose of the chapter well I always use against equity good conscience I just like the way it rolls off the tongue so that's the argument that we're paying Medicare is against equity and good conscience the Medicare manual has some great examples the first one there is the beneficiaries spent all the money that's an actual reason you can go to Medicare and say we don't want to repay your files oh man because the money is all spent now you can imagine that's probably not the most persuasive argument but it certainly one is listed in the manual as a Bible argument typically though there are there are arguments are on around income and resources for instance if your client is dual eligible so there are Medicare and Medicaid and clearly it's a hardship repayment air and and that's the kind of circumstance I'm extremely confident that we get a refund back from Medicare now we talked about refunds because we counts our clients to pay the final demand as I said you only have 60 days to make that payment where they start adding interest and we would hate the fact if our client didn't make that payment and then we're unsuccessful getting a waiver compromise to the interest accrued so we always talk about refunds once you make the payment and then we'll get a refund I know it's a little bit scary to think about getting from Medicare again that's why the check was actually a copy of check was actually presented to you to show they actually do issue refund now the table like we use here is a great story and not a great story about great story about Medicare refunds was a home invasion case in Orlando last year during a seven-year-old girl booked a party the little girls got away the mother was murdered and a grandmother was shot 9 depending on the medical record you read what I was able had good counselor great clients and it was secure you know a person settlement from negligent supervision of a housing complex she was already in section 8 and Medicaid Medicare's filed a man was about $160,000 and that was after reducing for fees and cost she paid it we got all of her money back in 30 days an understanding me yes she had over seven figures in a trust account but Medicare was understood she was now responsible to raise three grandchildren she was in her 80s that's not cheap her daughter going to college Falls I'm well aware of the expense of children as was Medicare so they gave all her money back my point being it a large settlement doesn't mean your client is entitled to a financial hardship waiver they looked at the complete you know resources available to your client in fact when you make the request for a hardship waiver your client fills out it's a social security for moment a copy with hearing I do know it it's uh security form 632 BK it is a terrible for the word Medicare appears nowhere on that form it talks about the overpayment of the Social Security benefits and change in repayment rate the terrible form and the first 12 questions about your clients fraud and obtain this Social Security overpayment now the rest of the form is nothing but a monthly budget and according to Medicare manual you're allowed to skip those first 12 questions you wouldn't know that lecture at the manual skip those first 12 questions because Medicare beneficiaries are considered honest - improvement otherwise the rest afford the monthly budget and I get pretty easy to fill out your client will fill that out and read a hardship letter now you don't write this letter we don't write this letter I also say is the only letter Medicare bothers to read now we give our clients a sample letter um in bullet point talking points like right here it happened help with the instructions how to fill it out now the client some clients write 10 pages they want to tell Medicare their story some plans rate five sentences the case I was talking about the grandmother was shot hers was a handwritten on loosely paper heads in person a long time she's written that less than half a page it was heartbreaking it was our breaking letter oh it was hard to read and as so Medicare gave all her money back now if the hardship waiver does not work or Medicare granted in part not in full we can decide to move forward with a compromise request now the hardship request is done by BCR see the commas are done by CMS with the hell of HHS attorneys now thank you again I brought some great ideas I so I thought because when you send a compromise request often to be CRC who is the the main conduit for confer information to Medicare they'll send you a letter saying we have no authority of you compromises we're forwarding this to CMS well I'm trying to find efficiency starts in here compromises directly as CMS well they'd send them right back saying we don't accept these they have to go through B CRC and then we said the BCR so you get the letter saying they don't have authority they're forwarding it to CMS so it's a circle the nice thing about that circle or the reality not nice at all is it and it has a policy of forty day turnaround time my correspondence so they were eight forty days tell us they're saying to somebody else then they were eight forty days to send it on so we added a nice any day delay to the process I bring that out bring it up because I see a lot of my clients who are frustrated Medicare because some lots of letters and then it'll seem like Medicare is not responding to their correspondence what's typically happening as letters are crossing in the mail trial attorneys are very good their paralegals are even better about staying on top of things Medicare is neither of those so usually three or four letters into Medicare Medicare respond to the first one um so kind of be aware of that in your practice now a Federal Claims collection act compromise is more like the general compromise you're used to writing in all your cases everything goes in there he's old she's injured Medicare it's not worth your time to come prosecutors claim it's against equity and good conscience let's read let's work this matter out Medicare at the end you make an offer now a we offer hundred bucks and I often joke that one hundred bucks is what it used to be because Medicare never takes it but they've actually taken it a few times lately let's say thanks to higher bucks we're refunding you $9,800 that situation that typically they'll say Dave no thanks for the hundred but with a twenty thousand instead of fifty here's a refund of thirty thousand dollars that's generally how it works that we're very successful in the waiver and compromise process we lost we have a lot of perfectly emotional investment in that particular service one because we built it to because people tell us it doesn't work and three because the way it actually operates my senior Medicare res a specialist really see a lot of pride in these and one of the cases she brought to my attention last week was a quadriplegic case settle for you know turn fifty thousand dollars all the covers there was Medicare took all the running after fees and costs it to one hundred and ninety thousand dollars one hundred sixty thousand dollars so then victim got nothing we're the compromise and Medicare refunded $80,000 now it's not all the money but without this process which are the people other creditors disparage in which trial attorneys are unaware of because Medicare hides it that injury victim we got nothing so at least we're able to give $80,000 you see why it's so close to our hearts this particular service now the last option if it's none of those other tools work the the last tool of toolbox is the best interest the program waiver and you now know all there's no but that way no more regulations there are no more statutes there's no case law that's all there is in fact I regular argues reading directors of Medicare about the nature of this waiver because it says best interests of the program Medicare says oh you're talking about waiving the interest on the unpaid principal no that's not what that word means in this context it is simply statutory authority enabling the secretary to waive any claim he or she thinks is appropriate that's all there is to it we talked about using the weird situations hopefully don't have these but French Ahn's weird circumstances so this is a kind of this is that one if nothing else really works we can use this to have a discussion with medic about why they should waive their claim I know I'm killing US war stories maybe but this came out that was really useful was that attorney in Tampa who had money in his trust account for eight years because he was Medicare Medicare stop respond to his phone calls stop responding to his letters completely weren't responding um the plaintiff wanted the money obviously and filed to bar complaints against the attorney to get the money out now long story short the turn is completely right and hold the money the bar backed him up from the previous actions of the plaintiff we did not repay Medicare and there's a lot of reasons but the attorney was right to hold the money but he wasn't happy to had the money and not happen to bar complaint we were to use this waiver to get Medicare to waive their claim in about four months so he was able to get the matter closed money Irish trust account and a client satisfied at least at least gone from his life using this waiver so I hope you don't have those situations and hopefully we can solve these some other process but it's not this is kind of a last-ditch attempt to try get Medicare C's to do something reasonable and get the matter resolved now if we recover the maker of Andy's plans I'm going to spend a little more time talking about the refund process and the logistics have it works in your office now remember once you've paid the final demand you were done you have satisfied your obligation to your client and to Medicare you can close the file in your office if you engage someone like synergy we can do this directly with your client because as administrative processes not legal representation if you want to keep in you're going to use if you want to do it yourself or if you want you involve synergy and keep your file open to maintain your lease with your client that's fine as well but the point being is you can be done and you can close your file and then then synergy or anybody else have known as what does is but us can step in and try to get a refund these processes in terminus traitor I walked you through how they operate if you get a refund back if we're successful getting your refund - ever sent the checks it should've checked me trust account a check will show up in your office made payable to the beneficiary um the great thing with that is you get a second check for your client mr. Mixon kind of walking billboard for the best attorneys in the world occasionally Medicare said check directory beneficiary because we're talking Medicare we have talked about what they do 80 percent of time because twenty percent of time you know what they're doing but that's how the process works I stress that because gave these refunds doesn't require any additional work for your firm it's something that is just going to benefit your client put money in their pocket and help you market although I know we're doing this elated I just quickly broke since energy fee senator doesn't take a fee on these on the refund process and less we're successful if we successfully get a refund our fee is 15 percent of that refund I'm a bringing up to everyone to say no our fee but also so you know we don't sell later will quickly triage your case and say whether or not it makes sense to try for in Savanna hardship waivers are easy when the triage again if your client is upper-middle class they're not going to get a financial hardship waiver doesn't mean can't you try for a compromise but they're not going to get the waiver under those criteria we make sure we don't sell again sell air to clients we don't want them to be excited about something simply not going to happen that's what I'm going to stress that there yeah I can talk about these questions at the end you have more the Mao plans move on to Medicare Advantage plans in our last topic for today Mao plans often call Medicare Part C or Medicare Advantage plans I remember back in the days and they're called Medicare Medicare risk HMOs I like Medicare Advantage plans under a lot of people don't I like it for several reasons one I like because they harken back to the days of bipartisanship believe it or not when I talk about my Parshin ship I'm talking about Newt Gingrich and Bill Clinton that is our image of bipartisanship today this is a 1995 they got together and came up with Medicare Advantage statute simply the idea being that Medicare can't couldn't handle the volume of the baby boomers so they enlisted private industry to act as Medicare it all breaks a little bit like the ACA in Medicare Advantage plans create a risk pool and are paid a per diem from Medicare to hanage to manage these claimants in addition they're allowed to charge a premium in addition to that stipend from CMS to the beneficiaries so operates very much like Medicare the difference being is it acts like normal insurance there'll be a dental part will be a vision part so so your client would have a Medicare Advantage card we'll use in more variety of places in the regular Medicare a and B and they won't have a supplement there is a supplement needed now the well goes a little bit of history of Medicare Advantage plans but this is their recovery rights they operate exactly the same now as Medicare it's a private cause of action I'll talk about that and the regulation here 480 108 F extends the private cause of action of Medicare Advantage plans and additionally CMS directors have repeatedly said that Medicare Advantage plans are same as Medicare now it's important about this as I said I was a bad guy for a long time on the other side and I used to collect a Medicare Advantage plan until 2013 Medicare Advantage plans had to use their own contract language as a basis for their recovery they couldn't use the Meccan derrickman Medicare secondary payer Act that change went Avandia to came out back to 13 has really changed now so essentially as of today think of Medicare Advantage as Medicare was some big problems with it first of all bring the problems they point out the liability you are personally liable to both Medicare and Medicare Advantage plans if they're not repaid that's always been true since 1980 has been true in fact you're liable for double damages if they're not paid within the 60-day deadline now what I know the past 45 minutes I've talked about Medicare adding interest that is what Medicare does there are lauda double damages but they don't if you don't make the pain within 60 days Medicare will add 10% interest it goes over four hundred and twenty days think it is they refer the case to the Department of Treasury who starts garnishing Social Security benefits they do not double damages one other things they'll do is they will withdraw the reduction for procurement costs so you don't get the benefit of Mercury cost because you haven't been helpful Medicare Advantage plans do not do that Humana in particular on the sixty-first day doubles the amount do so you home $10,000 today tomorrow you room $20,000 and I mean when I say you I mean you the Medicare manual instructs them to go first as a beneficiary then to trial counselor beneficiary then to defense carrier than the defense counsel so every raise on the hook that's the reason that when you're at mediation or or settlement and defense counsel is demanding is a pay Medicare or you want to copy the final demand or something along those lines they're not necessarily wrong in that because they do have skin in the game they are exposed as well unlikely Medicare set-aside issue which they have no exposure they have no reasoning with talker Medicare set-asides to you Medicare additional payments they do have an interest in that okay and it will point out to be notice attorneys just specifically listed as a resource which to make repayment to Medicare and Medicare Advantage plans or payment formula is the same as we talked about earlier if the amount equal or greater than a settlement they can get they can get all the money except for fees and cost if it's less they do the ratio I'll point that out because rawlings in particular makes the argument that they do not reduce for a kurma cost now their argument is without merit do not pay them on that simply do not they are completely 100% wrong their argument is that because their contract calls for repayment hundred percent and their contract is approved by CMS they're therefore at odds 100% they have no basis for that none at all they're now operating Medicare secondary payer Act and the irony this is when I was going to decide forever we were fighting the fight we wanted to win was his Medicare secondary payer act as a recovery vehicle and as soon as we win it or they win it Rawlings for his friend it drives them in both ways typical of Rawlings okay again this is the are gonna make with them don't pay that don't pay them back at full freight get to make reduction at a minimum one other thing I'll point out at this repayment point is Medicare Advantage plans our argument centers position is are required to at least do the same evaluation of all financial hardship I'm gonna compromise as CMS our argument is if you're going to use the Medicare secondary payer act as your recovery vehicle you have to use the whole thing and the whole thing includes those evaluations now we can't make it accept a reduction but they have to at least do the evaluation the nice thing about this process and whether is I don't I don't hate me it makes plays much of the regular Medicare is because you can have that compromise discussion before you make the payment so you could Medicare have these ridiculous make the payment get a refund Medicare Advantage plans because they're run by private industry and because you're dealing with optimum or rawlings or neck we on you could have a discussion about what is a reasonable repayment relying upon the statutory and regulatory framework that Medicare uses an evaluation but you don't have to wait to the end you get right up front then they get a number and satisfy it that's a great way to negotiate these liens okay how Medicare mantas plan has got so bad well I was expert witness in the case Parrish Blanc a man is Parrish blank here in Virginia last year and actually during while watching heard was ongoing but before the Eleventh Circuit ruled on it I haven't the cases are very similar we don't Western Heritage because it's the clearer one what happened here was stupid fall down in Miami right the end of the case players counsel realized that Humana had was involved they thought was only Medicare that letter for Medicare saying no no bills paid they're ready to settle the case who manage about $19,000 claimed the plant said okay I'll take care of it I'll pay for it Western Harry's defense carrier since the settlement check with ku Manas name as a payee the state court said take it off and reissue the check which they did well the plaintiff of course didn't pay Humana he sued the plaintiff they had some back-and-forth battles you may have got tired of suing the plaintiff and decided to sue western heritage defense carrier western heritage did what I would have recommended they did they put their $19,000 in trust told him and they're going to do that said let's litigate the issue and find an answer but all the way up the Eleventh Circuit they were losing Eleventh Circuit said yep we minute love and Circuit said you have to make payment within 60 days putting the money in a trust account is not making payment period and they went further to say the statute says that the damages shall be double not maybe double so they shall be double so they shall will be doubled and Russian hairs had to pay Humana $38,000 now right s them paying this lien three times they paid the balance I paid the value over to the plaintiff they paid Humana twice the amount unhappy day for western heritage similar situation in the parish blank case here in Virginia right where I live and work but the law firm was suit trial counsel will suit 491 thousand dollars times two similar facts they had 11 Medicare saying no bills paid no idea man was involved they got burned the problem is with regular Medicare you can contact be CRC there's a central repository and you know if Medicare's made payments Medicare Advantage plans there were hundreds of them yours unless you have some ability to narrow that down like client says I have that in the plan or you man I plan UHC plan you can't find it we can't find it you have to have something it doesn't need to be honest I need the insurance card in the claim number but yet they build narrow down to Humana at there or someone I'm to look for it and that's the difficulty you simply don't know added to that your client often doesn't know example I uses my my in-laws my father-in-law's on Medicare EMB my mother-in-law is on Medicare Advantage you asked them both to their insurance carriers they say Medicare and they would say it again so you really the best practices is to really grow your clients and insurance cards look through those bills make sure you'll see a payment from you man are you a 2 C or a or a P or something like that and when we watch out for our clients and the single biggest red flag it was existed in both these cases is if you have a Medicare final demand or case your pain amount of the zero somebody's paying those bills for your client easy to look further it's unlikely of a million-dollar case in new medical bills so that's the big red flag effect if you're one of our clients we have a case you'll pay them out of zero we actually prompt you to ask that question is there someone else paying these bills is there another insurance card have you gone through the bills to look for it there's no there's no substitute for legwork I'm sorry that's what they're really the only option there these these Humana and particulars are the most aggressive out there but always Advantage plans it's in their interest to keep you in the dark because if you missed a deadline you've missed a deadline they doubled their money humain it really is looking this is a profit Center I can only imagine some young fire attorney who built this process Humana and is now getting Pat's on the back for fines and millions of dollars now there's big companies out there doing this it company Miami MSP there's fine class actions you're seeing lots of this happening in work cop setting where they're suing that work comp carrier for double damages and in pip and no fault settings because there are some other cases we didn't talk about here's only the plaintiffs that say even statutory obligations like no-fault and create the elevation of pay and if Medicare's made a payment and pip is withholding the funds and therefore made visible in the fund double damages so it's really happening out there be aware of it again all I can say is keep your head in swivel and look those insurance cards and be aware if there is zero from Medicare that something might be fishing this is a bit of a commercial or nearing in this slide presentation I didn't work a commercial in but is their average reduction across lean types I keep track of the number at the top right the most because when I was on the other side I gave just about 98 million dollars back for the insurance company so I'm trying to pay my debt back back to the world so about halfway there some I'm just not even in this scale but not quite yet and then we came because we're plaintiffs only we're very focused on the savings we've cheat not we don't just prop process liens we fight these leads so those the commercial it certainly is I want to stress that if you're not hiring synonymy or our competitors fight on all these lien types yourself um I picked you this way you worked really hard to create the some the first spot my job for 15 years was to make a few phone calls in a few letters and have you send a big chunk of that to me either eight hundred thousand dollar a month goal when I was at the side and never had a problem making it it is a volume business on their side with huge money involved so fight these guys push back on them don't just roll over don't accept what they give you really try to make as much you give your client a thousand dollars here and there to real people matters it doesn't matter that much to you HC or to AARP to fight these liens every chance you get it how our pricing works enemies are our model here premier client side 15 percent earlier but our premier clients pay 10 percent that's our savings based on all lien types ten percent of savings we obtain is our feet so we're on see the client ten thousand dollars or peace five hundred bucks there's a fun dollar advance team you sent us a case but we don't see your client least $500 refund that money what your client always a better offer engaging synergy as I said earlier for the Medicare refund service there is no advance fee we're saying the way that comes into play makes no sense to charge in advance fee and our fee is only on the refund obtain all I want to say we cap our fees it's pre our clients ten percent not their class fifteen percent but the idea being is case of $100,000 lien you sell of case of $25,000 with the entire lien waived for a $10,000 fee that's going to eat up all your clients element so we cap our Fiat tens percent of the clients walk away so say walk with me after paying fees after paying costs and after paying the lien so it's truly your clients true net will never take more than ten if your percent if your premier client and our case managers people actually working the files get paid a bonus the more they saved your client so we're all aligned your client Saturday is a company and individual file handlers are trying to save as much money as possible because we're a financial motivation to do so you can rely on our altruistic point of view frankly you really can I'm on this side because I couldn't do those anymore but you don't have to we're financially motivated to work as hard for your client as we can the last slide really is the most important my phone number and email I've said a bunch of times but I'm here trying to help your clients try and help you please feel free to shoot me an email give me a phone call I said lose half my day giving out free advice we don't charge by the hour you see how we charge it we want to be a partner to our clients not every case makes us outsource but you have a quick question I have a quick question shoot me an email able to answer a lot quicker and save you in your office a lot of time and hopefully that will annuity your clients benefit are there any questions okay I don't questions popping up in the little window if you have questions please feel free to shoot me an email or Susan email and give her a call thank you for your time me