Medicare Secondary Payer Clearing the Hurdles of Compliance by alicejenny

VIEWS: 9 PAGES: 13

									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
  patients..
       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
       Disability


• 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
  secondary
       General Questionnaire Data


• Worker’s Compensation

• Black Lung

• Department of Veterans Affairs

• Government Grants/Research
        Accidents
        (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
        Liability


• 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
THANK YOU!

								
To top