Demystifying the MSP Rules

Kevin WillisDirector, Medicare OperationsClaim Services Inc

46th AnnualEducational Conference & Exhibition

Patient Access:  The First Connection to a Lasting Impression

 September 21 – 24, 2014

Medicare Secondary Payer

(MSP) Questionnaire

•Must contain the correct answers!

•Must come from a valid resource

• It is a tool

Medicare Questionnaire

•Worker’s Compensation

•Black Lung

•Department of Veterans Affairs

•Government Grants

Accidents (Non-Work Related)• Automobile

• Slip and Fall

• Product Liability

• Dog Bites

• Good Will

No-Fault Insurance

• Is what it says, “no fault”

•Medical money only!

• Policy limits are present

• Policy parameters are applicable

Liability

• Do you hold anyone responsible?

• Liability is determined by the patient

• Pursuit of dollars is required

• Can be multiple responsible parties

Entitlement

• Age

•Disability

• ESRD

•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

• Dual entitlement

• Coverage can term, it just can’t be secondary

Group Health Plans

• Beware the patient preference rule

• Just because they pay, doesn’t mean they should

•Medicare’s rules trump everyone else’s

Medicare Audits

• Accidents are big ticket

• Improper entitlement identification

• ESRD patients

• Understand the questions you ask

Questions?