Obtaining Reduction for Attorney Fee

Posted by Mary Skinner

Question:
Matt, As you may recall, my office has reached a business arrangement with yours for resolution of liens relating to our nursing home clients. One of my [cases] is far enough advanced in the lien resolution process that it would be counterproductive/non-economical to refer to you.

Would you please advise me of the legal authority for obtaining a one-third reduction for the attorney fee? I know this is commonly done but would like to cite some support in my letter. Further, can I submit my request for this further reduction with my challenge letter versus the charges not causally/temporally related, or is this accomplished as a two step process after exclusion of charges for causal/time issues?

-New York Attorney

Answer:
1. The legal authority regarding Medicare’s pro rata offset can be found in Title 42 CFR 411.37(c), it stipulates that Medicare will recognize a proportionate share of the necessary procurement costs incurred in obtaining the settlement.

2. As for disputing unrelated charges and requesting the final demand all at once, yes it can be done, however, please be aware that if Medicare does not agree with your argument and does not remove the claims in dispute they will issue you the final demand which must be paid within 60 days or interest will accrue. If you are still in disagreement with Medicare’s final demand amount you can request a re-determination and you would need to submit additional information Medicare that was not sent in your original request for removal of the claims. Should you have any questions please contact me.