COPYRIGHT © 2013 Discovery Health Partners Six questions to determine the health of your Medicare...
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COPYRIGHT © 2013 Discovery Health Partners Six questions to determine the health of your Medicare Secondary Payer program
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Transcript of 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
COPYRIGHT © 2013 Discovery Health Partners3
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
COPYRIGHT © 2013 Discovery Health Partners4
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%
COPYRIGHT © 2013 Discovery Health Partners5
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
COPYRIGHT © 2013 Discovery Health Partners6
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?
COPYRIGHT © 2013 Discovery Health Partners7
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.
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COPYRIGHT © 2013 Discovery Health Partners8
Want to unlock the value of MSP
for your organization?
Click for more information
Restore underpaid premiums and improve efficiency
with Discovery Health Partners
