MSP COMPLIANCE: A checklist to get ready
Medicare Secondary Payer (MSP) RACs collected $12.7 million in its demonstration project. Although CMS discontinued the MSP RACs, it will still check for MSP compliance in the nationwide permanent program.
Following are two important tips regarding the MSP from Kimberly Anderwood Hoy, JD, CPC, director of Medicare and Compliance for HCPro, Inc.:
1. Use CMS’s MSP form optionally. This is a common misunderstanding in patient access. CMS has a requirement to collect and report MSP information, but the questionnaire itself is optional. In response to a question from HCPro, Inc. after its July 16 Hospital Open Door Forum, CMS said the questionnaire is permissive in nature, but the same type of questions must be asked.
“Providers may use this as a guide to help identify other payers that may be primary to Medicare,” CMS interprets in its laws. “This questionnaire is a model of the type of questions that may be asked to help identify Medicare Secondary Payer (MSP) situations.”
2. Watch for errors in retirement dates, assumed insurance. CMS reports that most of the recoupments made by the MSP RACs are a result of claims when Medicare paid a provider when a different health insurance company should have. When a Medicare beneficiary gets health benefits through his or her job, CMS points out, that health insurance company is generally the primary payer. The government also revealed that facilities had entered information incorrectly in areas such as:
- Retirement dates
- Information on professors in California who teach well past their Medicare eligibility age
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