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!