Medicare Secondary Payer Clearing the Hurdles of Compliance

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

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