Medicare Liability Settlement Claim Reimbursement Summary

40.18 – Medicare Liability Settlement Claim Reimbursement Summary (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) The Medicare Liability Settlement Claim Reimbursement Summary provides a worksheet for use in calculating beneficiary procurement costs, Medicare’s share of the beneficiary’s procurement costs, and Medicare’s claim to be recovered as follows: MEDICARE LIABILITY SETTLEMENT CLAIM REIMBURSEMENT SUMMARY Beneficiary: HICN: 1. Amount of settlement $ 2. Medicare payments (identified by MSP Contractor) $ 3. Total Medicare payments $ 4. Attorney fees (% of line 1, if applicable) $ 5. Other procurement costs incurred by the beneficiary (per attorney) $ 6. Total beneficiary procurement costs (lines 4 + 5) $ 7. Ratio of beneficiary procurement costs to settlement (line 6 / line 1) % 8. Medicare’s share of beneficiary procurement costs (line 3 x 7) $ 9. Total Provider, Physician, or Other Suppliers’ Charges $ 10. Medicare’s claim to be recovered (the lesser of line 3 or line 9 minus line 8) $