Notifying MSPRC For Redetermination

Posted by Mary Skinner

Question:
We have a client who is Medicare eligible that had a total knee replacement related to a Motor Vehicle Accident paid for by Medicare. Initially, we received correct payment summary forms which included the correct Medicare payments for treatment related to the MVA, however, when we settled the case we received a letter stating Medicare did not pay any claims related to the MVA. I tried to correct this with MSPRC over the phone with no luck. Do I need to send an appeal to Medicare to receive the money? What process do I go through to get this corrected? We know for a fact Medicare has paid and do not want this to come back to haunt us.

Minnesota Attorney

Answer:
Yes, you would need to appeal this in writing to the MSPRC by requesting a "Redetermination" of their final demand. Labeling your letter in this manner will reduce the possibility of your letter getting forwarded to the wrong department.

Attorneys and/or beneficiaries have an obligation not only to notify the MSPRC when they have included non injury related claims in their listing but also when they have omitted related claims.

My Best,
Mary Skinner