All Medicare hospitals, physicians and other providers are responsible for correctly identifying the primary payor of every patient, and there are certain steps every provider should take when a beneficiary has Medicare Secondary Payor status, according to a recent Medicare Learning Network Matters (pdf) article.
MSP is when Medicare is not responsible for paying a claim first, but these are different from Medicare supplement, or Medigap, policies. Here are five key points, excerpted from the article, that hospitals should know when dealing with claims submissions and MSPs.
1. Collect full beneficiary health insurance information upon each office visit, outpatient visit and hospital admission.
2. Identify the primary payor prior to submission of a claim, and bill the appropriate reasonable payor(s) for related services.
3. For multiple services, bill each responsible payor(s) separately. Do not combine unrelated services on the same claim to Medicare. Consequently, if you render treatment to a beneficiary for accident-related services and non-accident-related services, do not submit both sets of services on the same claim to Medicare. Send separate claims to Medicare: one claim for services related to the accident and another claim for services not related to the accident.
4. Providers, physicians and other suppliers should always use specific diagnosis codes related to the accident or injury. Doing so will promote accurate and timely payments.
5. Providers should report directly to the Coordination of Benefit Contractor any changes to beneficiary, spouse and/or family member's employment, accident, illness or injury, federal program coverage changes or any other insurance coverage information.
MSP is when Medicare is not responsible for paying a claim first, but these are different from Medicare supplement, or Medigap, policies. Here are five key points, excerpted from the article, that hospitals should know when dealing with claims submissions and MSPs.
1. Collect full beneficiary health insurance information upon each office visit, outpatient visit and hospital admission.
2. Identify the primary payor prior to submission of a claim, and bill the appropriate reasonable payor(s) for related services.
3. For multiple services, bill each responsible payor(s) separately. Do not combine unrelated services on the same claim to Medicare. Consequently, if you render treatment to a beneficiary for accident-related services and non-accident-related services, do not submit both sets of services on the same claim to Medicare. Send separate claims to Medicare: one claim for services related to the accident and another claim for services not related to the accident.
4. Providers, physicians and other suppliers should always use specific diagnosis codes related to the accident or injury. Doing so will promote accurate and timely payments.
5. Providers should report directly to the Coordination of Benefit Contractor any changes to beneficiary, spouse and/or family member's employment, accident, illness or injury, federal program coverage changes or any other insurance coverage information.
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