Medicare Releases Guidelines To Self-Calculate Conditional Payments In Physical Trauma Based Injury Cases

Medicare has released guidelines which will allow lawyers representing clients injured in certain types and sizes of cases to self-calculate the amount which must be repaid to Medicare. The self-calculation option is limited to physical trauma based cases. It is not available for non-trauma cases such as pharmaceutical claims, defective medical devices or chemical exposure cases all of which involve injuries which did arise from a single producing event. The total recovery must not exceed $25,000.00. The injury producing accident must have occurred at least six months prior to the self-calculation. Medical treatment must be complete and no further medical anticipated. The lack of a deed for any further accident related future medical treatment may be established either with a written statement from a physician or by a certification from the claimant that medical treatment has been complete for at least 90 days and that no further medical treatment is anticipated.

Medicare’s self-calculation procedure provides a streamlined procedure for smaller trauma cases such as commonly result from automobile accidents. Because treatment is complete the Medicare Set-Aside issues are avoided. Further information may be obtained at www.cms.gov/cobgeneralinformation/