A Court decision was recently rendered in Wisconsin which addresses the intracacies of claims submission to medicare in situations involving treatment of patients involved in “tort” or negligence cases where there is a third party- insurer available to pay for treatment expenses. That third party can commonly be a workers compensation insurer of the patient’s employer or liablity insurer of a negligent driver involved in an accident with the doctor’s patient. In the case of Conrad Laska v. General Casualty Company, the Wisconsin Appellate court noted several important medicare reimbursment concepts in these types of situations. In this case, a hospital filed a statutory lien against a tort or third party payor seeking payment out of any eventual settlement or jury verdict, rather than billing medicare for an injured parties treatment. The Court reviewed several medicare reimbursement concepts in its decision which are worthy of consideration by the chiropractor treating patients involved in these situations. First, the Court reviewed the “Provider Agreement Statute” (42 USC 1395cc-Special “legal speak” for the United States Code) Under this statute, a provider participating in the medicare program “may not charge any individual or any person for…services for which such individual is entitled to payment under
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