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SNEAK PEEK: Your MSP checklist

Patient Access Weekly Advisor, August 27, 2008

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You have enough to worry about as a patient access manager without the Medicare Recovery Audit Contractor (RAC) nationwide hospital-auditing program.

But you should be focused on it, especially in light of the fact that government auditors collected $12.7 million in its Medicare Secondary Payer (MSP) RACs.

Check out the two tips below regarding the MSP. (To read the rest of them, read Patient Access Advisor’s upcoming October edition.)

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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