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MEDICARE SECONDARY PAYER

Learn about Medicare Secondary Payer rules and coordination of benefits with this questionnaire. Ensure correct answers for effective claim submissions. Beware misconceptions and liability factors in various insurance scenarios. Address non-cooperative patient situations and be aware of auditor triggers.

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MEDICARE SECONDARY PAYER

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  1. MEDICARE SECONDARY PAYER

  2. Medicare Secondary Payer (MSP) Questionnaire • Must contain the correct answers • Must come from a valid resource • Must walk hand in hand with claim submission • It is a tool

  3. Coordination of Benefits • Medicare’s rules trump all others • A only.. B only • Multi-group plans • VA

  4. Employed versus Unemployed • Payroll and/or FICA Tax • Retired • Banked Hours • Long Term Disability • COBRA Coverage

  5. End Stage Renal Disease • 30 month coordination period • Employment data is irrelevant • Dual entitlement • Coverage can term, it just can’t be secondary

  6. Commercial Misconceptions • Beware the patient preference rule • Just because they pay, doesn’t mean they should • Personal policies

  7. Automobile Slip and Fall Product Liability Dog Bites Good Will Malpractice Accidents (Non-Work Related)

  8. No-Fault Insurance • Is what it says, “no fault” • Medical money only! • Policy limits are present • Policy parameters are applicable

  9. Liability • Do you hold anyone responsible? • Liability is determined by the patient • Pursuit of dollars is required • What constitutes a correct answer is subject to change

  10. 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 • Patient doesn’t have to believe you

  11. Auditor Triggers • Accidents • Improper entitlement identification • ESRD patients • Understand the questions you ask

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