Deciding whether to handle lien resolution in-house or to outsource it is a crucial decision for personal injury law firms. Outsourcing lien services can provide significant benefits for complex and specialized liens, which are most lien types, while some liens may be better handled in-house. This blog post outlines the types of liens typically suitable for outsourcing and those better resolved by the firm in-house, along with key considerations for managing liens internally for the ones which aren’t outsourced.
Liens Suitable For Outsourcing
Medicare
Medicare Conditional Payments: These involve complex regulatory requirements and detailed negotiation processes. Achieving significant reductions often requires seeking a compromise or waiver, making outsourcing to specialized firms advantageous.
Medicare Advantage (Part C) Liens: Similar to traditional Medicare Conditional Payments, these require specialized knowledge to navigate the unique aspects of Medicare Advantage plans, including potential double damages and personal liability.
Medicaid Liens – Medicaid Third Party Liability: Governed by complex, state-specific regulations, these liens often require detailed negotiation processes, such as seeking an Alhborn reduction. Outsourcing ensures compliance and maximizes reductions.
ERISA Liens– Employer-Sponsored Health Plan Liens: Governed by federal law, ERISA liens involve detailed plan documents and subrogation provisions. Outsourcing is beneficial due to the technical legal expertise required.
FEHBA – Federal Employee Health Benefits Act Liens: These involve intricate federal regulations, making them challenging to interpret. Specialized firms handle these complexities efficiently.
Military Liens – Military Health Plan Liens: Similar to FEHBA liens, these are governed by specific federal laws and benefit from specialized handling.
Large or Complex Private Health Insurance Liens: Outsourcing can help manage extensive documentation and negotiation required for substantial private health insurance liens.
Hospital and Provider Liens: Significant medical bills often involve large hospital or provider liens. Outsourcing can assist in managing extensive documentation and negotiation required to reduce these claims.
Multi-Jurisdictional Liens: When a personal injury case involves medical treatment in multiple states, outsourcing to firms with multi-jurisdictional expertise can be beneficial.
Liens Typically Not Appropriate For Outsourcing
Small Liens: Small liens may not be cost-effective to outsource. Law firms can often handle these liens more efficiently in-house. However, as our friends at Synergy can share, some firms do accept liens of any size for resolution, leaving the decision to the firm’s discretion.
Local Providers with Ongoing Relationships: For liens involving local providers with established relationships, handling these liens in-house helps maintain goodwill and may lead to more favorable negotiations.
Workers’ Compensation Liens: These liens, governed by state-specific laws, can often be resolved more effectively by attorneys familiar with local workers’ compensation practices and regulations.
Medicaid Estate Recovery Liens: Typically managed by state agencies with unique procedures, these liens are best handled by law firms that understand state-specific nuances.
Key Considerations For Handling Liens In-House
If you choose to handle certain liens in-house, it is crucial to understand the intricacies involved. Below are key concerns and questions that personal injury lawyers must address to ensure effective lien resolution.
Legal Obligations and Personal Liability
What are my legal obligations as plaintiff’s counsel, and am I personally liable? Plaintiff’s counsel must ensure all liens are properly identified, negotiated, and resolved. Failure to do so can result in significant legal consequences, including personal liability for unpaid liens.
Identifying Liens and Obligations
Is there a lien, reimbursement obligation, or just a debt? Determining the nature of the obligation requires meticulous investigation and analysis, including reviewing medical records, insurance policies, and correspondence from potential lien holders.
Scope of Reimbursement Obligations
Is the reimbursement obligation limited to past payments or does it include future payments? Understanding the scope of reimbursement rights involves reviewing plan terms and legal issues, including calculating future medical costs.
Jurisdiction-Specific Laws
Are there any state-specific laws that impact lien resolution? State-specific laws can significantly affect lien resolution. Attorneys must stay updated on relevant laws and regulations, which vary from state to state.
Applicable Laws for Non-Government Benefit Plans
What law applies to non-government benefit plans? Determining whether the plan is governed by state or federal law, such as ERISA, FEHBA, or FMCRA, requires understanding complex legal frameworks and their interactions.
Identifying Plan Administrators and Recovery Vendors
Who is the plan administrator and recovery vendor? Identifying the correct entities is essential for effective lien resolution and involves establishing communication and negotiating with large, bureaucratic organizations.
Verification of Plan Type and Recovery Rights
Can the plan or vendor prove its type and recovery rights? Verifying the legitimacy of the plan and its recovery rights involves scrutinizing documentation and challenging.
As you can see from the foregoing, outsourcing offers substantial advantages for managing complex and specialized liens, ensuring compliance with intricate regulations and achieving optimal reductions. However, smaller liens, those involving local providers, and certain state-specific claims may be better managed internally to maintain relationships and leverage local expertise. Each firm must carefully evaluate the nature and scope of each lien, considering their own capacity and the specific requirements of the lien type. By strategically balancing in-house resolution with outsourcing, personal injury law firms can ensure efficient and effective operations, ultimately benefiting their clients and the practice. If your firm needs help with liens, contact an outsourcing service near you for more information.
