“How much will my case settle for ?” and “When will I get my settlement?” are two of the biggest questions asked by clients in a workers’ compensation or personal injury case. Medicare beneficiaries will soon better know the answers to these questions.
As of April 1, the Centers for Medicare and Medicaid Services will allow conditional payments to be made electronically. The change to an electronic payment system will allow all authorized users to view the updated demand status of CMS and track electronic payments in the “Electronic Payment History” tab.
This change should allow Medicare beneficiaries who have a workers’ compensation or personal injury claim to have their cases settle sooner and receive their settlement proceeds sooner.
A Medicare conditional payment is a payment made by Medicare in a disputed workers’ compensation or personal injury case. In a conditional payment situation Medicare will pay on a medical expense but demand that they be paid back from the proceeds of a settlement or judgment.
In substance a conditional payment issues is like any other subrogation issue where some form of health insurance pays for an injury that should be covered under workers’ compensation or a liability policy. In all cases, the plaintiff needs to know how much can be repaid so they can settle a claim and know what they might receive in a settlement.
In a Nebraska workers’ compensation case, under Neb. Rev. Stat. 48-120(8),a judge can order that a third-party who paid for medical care that was related to be a work injury be reimbursed for payments made on behalf of an injured worker.
The problem with Medicare is that the conditional payment process is often more burdensome than determining a subrogation or repayment interest from other types of insurers – it often takes longer as well. Hopefully electronic payment and tracking of payments will simplify and speed up settlements involving Medicare beneficiaries.