Medicare Secondary Payer, Clearing the Hurdles of Compliance Kevin Willis Director of Medicare...

Medicare Secondary Payer, Clearing the Hurdles of Compliance

Kevin WillisDirector 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!