Medicare Secondary Payer Clearing the Hurdles of Compliance by alicejenny


									Medicare Secondary Payer, Clearing
the Hurdles of Compliance

Kevin Willis
Director of Medicare Operations,
Claim Services Inc
       Medicare Secondary Payer
       (MSP) Questionnaire

• Must contain the correct answers!

• Must come from a valid resource

• Must be completed for all Medicare
       Reasons for Entitlement

• Entitlement due to age, disability, or End
  Stage Renal Disease (ESRD)

• At 65, age provision takes over

• Must allow for dual entitlement
       Age Entitled

• Medicare entitlement, beginning of month
  patient turns 65.

• 20 or more employees

• Spouse only

• Retirement dates defaults

• 100 or more employees

• Family member of any kind

• Retirement date equals last date worked

• COBRA coverage…
       End Stage Renal Disease

• 30 month coordination period

• Employment data is irrelevant

• Coverage can term, it just can’t be
       General Questionnaire Data

• Worker’s Compensation

• Black Lung

• Department of Veterans Affairs

• Government Grants/Research
        (Non-Work Related)

• Automobile
• Slip and Fall
• Product Liability
• Dog Bites
• Good Will
• Malpractice
        No-Fault Insurance

• Is what it says, “no fault”

• Medical money only!

• Policy limits are present

• Policy perimeters are applicable

• Do you hold anyone responsible?

• Liability is determined by the patient

• Pursuit of dollars is required

• Can be multiple responsible parties
       Non-Cooperative Patients

• The patient must be able to provide the
  information or action that is required

• The patient must be informed that their
  actions will make them self-pay

• Examples
       Medicare Audits

• Accidents

• Improper entitlement identification

• ESRD patients

• Understand the questions you ask

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