Friday, December 12, 2008

SSI or SSDI Disability and Medicare Lien / Hospital Billing Codes

Posted by Matthew Garretson

I have a Social Security disability Medicare lien question that I hope you can help me with.

My client was a 40-year-old suffering from severe bipolar disease, and social security disabled. I don't know if it was SSI or SSDI. I do know she had a Rhode Island Medicaid card.

When she was hospitalized in Florida, she presented her RI Medicaid card for insurance coverage. I have cleared up any possible Medicaid liens, but want to make sure there is no Medicare lien, as I have been told that both could have used to pay the hospital bill. Does that make sense?

To no avail, I have made numerous attempts in the last 18 months to find out if there is a potential Medicare lien. I have been told I should get a conditional lien amount soon, but for all I know it could take another 18 months. Problem is that the defense wants to settle the case now. I don't see how I can do that until the Medicare issue is cleared up. Do you agree?

Is there is a way to determine from the itemized billing statement what the maximum lien could possibly be? There are 2 different figures for "contractual adj", and what does that term mean? Does it indicate payment received (from either Medicaid or Medicare), or does it definitively indicate an amount that was written off for some reason by the hospital? In the "type" column it for those 2 amounts it says "all".

Also, there is another entry for about 10% of the bill. Adding that to either "contractual adj" amount yields a total that is more than the entire bill. In the "type" column it says "Ins"), and it the "comment" column it says "ERA MC P". Is that some type of payment?

A bill requesting payment for difference between the larger "contractual adj" amount and the total bill was sent to my deceased client. Would my client be billed for that amount if Medicare had made any payments? It does not seem to in any way take into account the "ERA MC P" figure.

All help is appreciated. Thank you in advance.

-Rhode Island Attorney

It is very common for individuals to have both Medicare and Medicaid for a variety of reasons. Perhaps Medicaid is paying the co-insurance and deductible for a person's Part A and Part B Medicare coverage. Or, perhaps Medicaid rolled them onto Medicare Part D for prescription drugs (which is a big number for individuals suffering from Bi-Polar disease and taking type 2 Anti-psychotic drug products.)

I am happy to have someone here take a look at the bill. Contact me next week if you would like.