Medicare as a Secondary Payer (MSP)

1. Medicare as a Secondary Payer (MSP) February 2012

2. Medicare • There are two parts to Traditional Medicare • Hospital (Part A) • Medical (Part B) • Once a patient meets eligibility requirements they are automatically eligible for Part A benefits at no additional cost to the patient • Part B is optional coverage that is provided to a patient for a monthly fee that is deducted from the patients social security payment

3. What is eligibility based on? • Age • Once a patient reaches age 65 and has paid Social Security Taxes • Disability • As determined by Medicare • End Stage Renal Disease/ESRD • Permanent Kidney Failure • It is possible for a patient to have Medicare based off a combination of Age and ESRD or a combination of Disability and ESRD, but they can not have Medicare based on both Age and Disability

4. What does the prefix/suffix mean in the Medicare ID #? • A patient may be a dependent of a beneficiary to Medicare in which case they too may be eligible. • Medicare indicates why the patient is eligible by using the appropriate alpha prefix or suffix in the patient Medicare ID # • Examples: • A-Collecting • B-Spouse Collecting • C-Parte of Disabled • D-Deceased Spouse

5. SubscriberInformation • The patient is always the subscriber when billing Medicare, regardless if they are the beneficiary or a dependent. • The subscriber name must always be entered as it appears on the patient’s card, otherwise Medicare will deny the claim.

6. Subscriber Information • Pay close attention to: • Exact patient name • Type of insurance coverage • Effective date of coverage • Claim rejections or denials could occur if complete information is not obtained and supplied on the Medicare claim form submitted.

7. The accuracy and verification of the Medicare card information is extremely important because this information will be used on many claim forms and medical documentation materials throughout the patient’s history with the provider’s office. • Mistakes in patient information can carry over to Medicare claims, causing claim rejects, delays and even denials. These mistakes cause more work and can be quite costly.

8. Medicare Secondary Payer • Medicare Secondary Payer (MSP) is a term used by Medicare when Medicare is not responsible for paying a claim first. • It is equally important to verify the patient’s “other” insurance benefits. This will allow the office to identify those insurance plans that could be primary to the Medicare program, coverage that should pay instead of Medicare or that pay as a supplemental insurance.

9. MSP • As a Medicare provider PVMG is required to identify all possible insurance coverage's by asking the beneficiary about other insurance coverage prior to submitting a bill to Medicare • Verifying MSP information means confirming that the information furnished about the presence of another payer that may be primary to Medicare is correct, clear, and complete and that no changes have occurred.

10. When do we ask the MSP Questions? • When a patient covered under traditional Medicare first presents for services and indicates that they also has another insurance plan in addition to Medicare. • At future visits we ask the questions in the following situations: • It’s been over 1 year since the last MSP was obtained • If the patients insurance coverage has changed in any way

11. Why do we ask MSP Questions? • As the baby boomers generation moves towards retirement it becomes critical to maintain the viability and integrity of the Medicare Trust Fund. • Medicare saves over $6 billion annually on claims processed by insurers that are primary to Medicare • It is the providers responsibility ti nauntaun accurate, up to date information about Medicare beneficiaries.

12. Why do we ask MSP Questions? • Failure to obtain information listed in the questionnaire is a violation of our provider agreement with Medicare and could result in fines and penalties, including but not limited to the return payments made by Medicare. • PVHS can also be fined up to $2000 per account for knowingly, willingly, and repeatedly providing inaccurate ifnoarmion relating to the existence of other benefit plans.

13. How does PVMG benefit from the MSP questionnaire? • PVMG may receive more favorable reimbursement rates by billing both primary and secondary payers as appropriate. • Less time and resources wasted on refunding and re-filing claims to the appropriate primary insurance. • PVMG benefits by knowing that we are providing World Class Services to our patients by ensuring that their claims are billed correctly.

14. Where can I find MSP Questionnaire? • Once your are in the patients registration screen, choose Quick Documents. The MSP is located under PVMG-Medicare Secondary Payor • This will auto populate the patient information on the form

16. Filling out the MSP Questionnaire • You want to fully understand the MSP so that you can explain the questionnaire to your patients in a positive manner. • Please refer to the MSP Questionnaire reference sheet. • In Additional Info mark date MSP was completed.

18. QUESTIONS?