Medicare Secondary Payer, Clearing the Hurdles of Compliance Kevin Willis Director of Medicare...
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Transcript of Medicare Secondary Payer, Clearing the Hurdles of Compliance Kevin Willis Director of Medicare...
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!