Edition 8:
Medical Liens and Payments
Medical Liens and Payments
Chad Cook, principal at Beasley Allen Law Firm, asked Epiq: How are medical liens and payments best prioritized and handled when decades have passed between date of injury and disbursement?
- When Epiq is engaged for lien resolution, each settlement receives a thorough review to ensure that our methodology comprehensively addresses both legal requirements and coverage limitations as it relates to the specific nuances of each settlement.
- Our lien resolution process is a structured, multi-step approach designed to resolve possible obligations by verifying, negotiating, and satisfying valid liens from insurance providers with potential claims. Through this process, Epiq works to maximize the claimant’s recovery by auditing claims, contesting unrelated charges, and employing various strategies to reduce lien amounts.
- We start with an in-depth analysis of the injury date, settlement date, and relevant disbursements, an essential step for accurately determining the period during which lienholders may assert their right of recovery.
- It is crucial to recognize that the lienholders’ rights of recovery are directly linked to the timeframe established by the injury and settlement dates. By determining these timelines, Epiq ensures accurate recognition and enforcement of the lienholders’ rights and minimizes resources spent on improper claims that do not fall within the time period.
- Collaboration with each client is central to this process, as we communicate our findings to ensure clients have a clear understanding of each agency’s rights and limitations. This transparency enables clients to make well-informed decisions and remain aware of any constraints or obligations that may affect the outcome or amount of recovery.
- Rather than relying on a fixed formula, Epiq conducts a comprehensive evaluation of all relevant factors specific to each settlement while communicating and partnering with clients to maximize the claimant’s recovery and provide necessary closure.
Alexandra Clark, Client Services Manager
- When decades separate the date of injury from disbursement, the complexity of lien resolution grows exponentially. Over that span, coverage changes, statutes of limitations come into play, and lien obligations multiply.
- From an operational perspective, we often see multiple coverages and competing liens – Medicare, U.S. Department of Veterans Affairs (VA), Defense Health Agency (DHA), Medicaid, ERISA plans, and other private insurers all asserting recovery rights.
- Traditionally, Medicare held the first right of recovery. Recently, however, Epiq has seen a rise in other governmental agencies like the VA and DHA/Tricare seeking reimbursement alongside Medicare.
- As a result, Epiq is adapting its approach to lien resolution. We’re adjusting processes and protocols to address these competing entitlements, while still ensuring compliance and protecting claimant recoveries. This includes mapping every potential lienholder earlier in the process, auditing historical records, and negotiating when priorities may conflict.
- Timing becomes an important consideration as decades-old claims often require compromise or waiver requests, and statutes of limitations and other factors can impact enforceability.
- Resolving liens after decades is an operational balancing act. Success comes from blending regulatory knowledge with practical process management, ensuring accurate resolutions that honor both the law and the claimant’s best interest.
- By adapting to shifting priorities among governmental agencies and addressing all potential lien obligations holistically, Epiq delivers the best possible outcomes for our clients.
Jason Hammerschmidt, Senior Operations Manager
- At Epiq, we focus on ensuring compliance while maximizing claimant recovery. When decades pass between date of injury and settlement for an injured party, it is essential to carefully evaluate the validity of all potential liens, prioritize legally enforceable claims, and explore strategies for lien reduction.
- To do this, it’s important for Epiq to review and understand the applicable federal and state statutes at play for each settlement.
- Generally, government liens, enforced under federal and state statutes, take precedence over private liens. Even so, the federal and state laws that grant lien enforcement authority to agencies such as Medicare, the U.S. Department of Veterans Affairs (VA), and Medicaid often include recovery limits.
- For example, the federal Medical Care Recovery Act (MCRA) includes a provision for excluding portions of third-party payments not attributable to medical expenses. In instances where litigation is impractical or the injured party faces undue hardship, military lien recovery rights allow agencies to reduce or entirely waive the federal MCRA lien.
- When a particular state lien is in place, it’s important to reference the applicable state statutes as state programs operate under the laws of each individual state.
- However, while each state is individualized, all state Medicaid programs are constrained by the U.S. Supreme Court’s 2006 decision in Arkansas Department of Health and Human Services v. Ahlborn, which holds that Medicaid lien recovery is limited to reimbursement solely from the portion of a settlement allocated to medical expenses.
- By using a mix of legal scrutiny, strategic negotiation, and priority protocols, Epiq ensures thorough lien review and resolution while maintaining a claimant-first approach to achieve the most favorable outcome.
Danielle Hudson, Esq., Project Director, Strategy and Advisory Services
- Epiq works hard to provide closure to claimants following an often prolonged settlement process, while still maintaining focus on the details that drive the lien resolution process.
- Clear communication with our clients, guided by empathy for the harm their claimants have experienced, plays a key role in achieving the best lien resolution outcomes in decades-old matters.
- We obtain claims from a multitude of government agencies and lien recovery vendors, audit them for injury relatedness, and negotiate them to resolution. Our multi-step lien resolution process is designed to achieve the most favorable repayment obligation for claimants, but the process can be tailored based on the needs specific to each claimant.
- Oftentimes, the most favorable results are based on award amount. However, this is not always the case. Timelines for responses vary across government agencies and lien recovery vendors at each step of the process, and so, for some claimants, expediency may be more favored.
- If timeliness is important, perhaps audits for relatedness are bypassed if the percentage of the claim relative to the gross settlement is less than an agreed-upon threshold. Epiq develops a consultative relationship with our clients to understand both the settlement landscape and how the client’s goals can fit smoothly within the lien resolution process framework at Epiq.
- By having these conversations upfront and establishing clear expectations around the details during the implementation phase, our experts are positioned to collaborate with clients to ensure efficient and empathy-driven lien resolution.