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Download Medicare Secondary Payer, Clearing the Hurdles of Compliance Kevin Willis Director of Medicare Operations, Claim Services Inc

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  • Medicare Secondary Payer, Clearing the Hurdles of ComplianceKevin WillisDirector of Medicare Operations, Claim Services Inc

  • Medicare Secondary Payer (MSP) QuestionnaireMust contain the correct answers!

    Must come from a valid resource

    Must be completed for all Medicare patients..

  • Reasons for EntitlementEntitlement due to age, disability, or End Stage Renal Disease (ESRD)

    At 65, age provision takes over

    Must allow for dual entitlement

  • Age EntitledMedicare entitlement, beginning of month patient turns 65.

    20 or more employees

    Spouse only

    Retirement dates defaults

  • Disability100 or more employees

    Family member of any kind

    Retirement date equals last date worked

    COBRA coverage

  • End Stage Renal Disease30 month coordination period

    Employment data is irrelevant

    Coverage can term, it just cant be secondary

  • General Questionnaire DataWorkers 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 InsuranceIs what it says, no fault

    Medical money only!

    Policy limits are present

    Policy perimeters are applicable

  • LiabilityDo you hold anyone responsible?

    Liability is determined by the patient

    Pursuit of dollars is required

    Can be multiple responsible parties

  • Non-Cooperative PatientsThe 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 AuditsAccidents

    Improper entitlement identification

    ESRD patients

    Understand the questions you ask

  • THANK YOU!

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