Medicare Secondary Payer, Clearing the Hurdles of Compliance

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Medicare Secondary Payer, Clearing the Hurdles of
Compliance

• Kevin Willis
• Director of Medicare Operations, Claim
  Services Inc

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Medicare Secondary Payer (MSP) Questionnaire

• Must contain the correct answers!
• Must come from a valid resource
• Must be completed for all Medicare patients..

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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

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Age Entitled

• Medicare entitlement, beginning of month patient
  turns 65.
• 20 or more employees
• Spouse only
• Retirement dates defaults

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Disability

• 100 or more employees
• Family member of any kind
• Retirement date equals last date worked
• COBRA coverage

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End Stage Renal Disease

• 30 month coordination period
• Employment data is irrelevant
• Coverage can term, it just cant be secondary

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General Questionnaire Data

• Workers Compensation
• Black Lung
• Department of Veterans Affairs
• Government Grants/Research

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Accidents (Non-Work Related)

• Automobile
• Slip and Fall
• Product Liability
• Dog Bites
• Good Will
• Malpractice

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No-Fault Insurance

• Is what it says, no fault
• Medical money only!
• Policy limits are present
• Policy perimeters are applicable

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Liability

• Do you hold anyone responsible?
• Liability is determined by the patient
• Pursuit of dollars is required
• Can be multiple responsible parties

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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

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Medicare Audits

• Accidents
• Improper entitlement identification
• ESRD patients
• Understand the questions you ask

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THANK YOU!