COPYRIGHT © 2013 Discovery Health Partners Six questions to determine the health of your Medicare...

COPYRIGHT © 2013 Discovery Health Partners

Six questions to determine

the health of your

Medicare Secondary Payer

program

COPYRIGHT © 2013 Discovery Health Partners2

How many MSP records does your plan have on file with

CMS?

The lower the better!

The number of MSP records as a ratio to your total

membership is a key indicator of how well your program

is performing.

1


What percent of attempts to

validate other coverage

are successful?

2

Are you reaching out to members directly?

Instead, contact other insurance and maintain accurate records of the

conversation. Case management tools and a contact database of other

insurance can help.

Don’t settle for less than 100% on every record


Using ECRS Web (instead of batch updates) to communicate eligibility updates to CMS can

result in 30% - 40% higher rate of success restoring premiums.

3What percent of

ECRS submittals

are accepted on your first attempt?

Aim for 99%


The positive MSP Adjustment Ratio measures the ratio of positive to

negative adjustments due to MSP.

The higher this ratio is, the better.

What is your

Positive MSP Adjustment Ratio?4


For payers that offer Medicare Advantage and Commercial coverage – be sure the

Commercial plan reports the member’s coverage termination to CMS as soon as the

member becomes primary on the Medicare Advantage plan. This will result in

maximized premiums and properly paid claims.

5 How does

Section 111 reporting

impact MSP records reported for your MA membership?


Are you tracking restoration of premiums due to MSP?

Track your success

Capture the status of MSP records along the process. This “audit trail” will make

it easier to respond to CMS compliance audits, communicate across

departments, and reconcile financial impact.

6


Want to unlock the value of MSP

for your organization?

Click for more information

Restore underpaid premiums and improve efficiency

with Discovery Health Partners

COPYRIGHT © 2013 Discovery Health Partners Six questions to determine the health of your Medicare...

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