Medicare and You

SECONDARY PAYER QUESTIONAIRE

Medicare is showing increased interest in obtaining the information contained within the Medicare Secondary Payer questionnaire. This information is needed to ascertain whether Medicare will be the primary payer or if another third party payer is responsible. This data needs to be collected with each admission and readmission on Medicare.

Best practice appears to be when this data is collected with the admission documents, either by the business office or social services.

In the Medicare Secondary Manual it states:

Responsibilities of Providers under MSP

As a Part A institutional provider (i.e. hospitals), you should:

• Obtain billing information prior to providing hospital services. It is recommended that you use the Centers for Medicare & Medicaid Services' (CMS') questionnaire, or a questionnaire that asks similar types of questions; and
• Submit any MSP information to the intermediary using condition and occurrence codes on the claim.

The Secondary Payer Questionnaire can be found at: http://www.cms.hhs.gov/Transmittals/downloads/R53MSP.pdf

DENIALS

During recent facility visits it has become more apparent that not all facilities are issuing denials on admission when benefits are not available or coverage can not be issued. In the provider agreement it states that the provider will inform the beneficiary in writing when benefits are not provided. Without the denial letter the resident cannot be held liable for the stay or days following the end of coverage until benefit days exhaust or a denial is given. The facility can not bill Medicare either. The denial letter referred to is not the expedited appeal letters used during the stay to inform beneficiaries of their appeal rights before the denial letter is issued.

If you have questions about either of these issues please feel free to call Cindy Fronning, RNC, CDONA, RAC-CT, Director of Clinical Reimbursement 651-324-8415.