MEDICARE SECONDARY PAYER

MEDICARE
SECONDARY PAYER
Clearing the Hurdles of Compliance
Kevin Willis
Christy Stansfield
Claim Services Inc
ProMedica Healthcare
Medicare Secondary Payer
(MSP) Questionnaire
• Questionnaire is a tool
• One rule to follow
• Disability versus Age
• Everything counts
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Employed Versus Unemployed
• Payroll and/or FICA Tax.
• Banked Hours
• Long Term Disability
• Personal Policies
2
General Questionnaire Data
• Worker’s Compensation
• Black Lung
• Department of Veterans Affairs
• Government Grants
3
Accidents
(Non-Work Related)
• Automobile
• Dog Bites
• Slip and Fall
• Good Will
• Product Liability
• Malpractice
4
No-Fault Insurance
• Is what it says, “no fault”
• Medical money only!
• Policy limits are present
• Policy parameters are applicable
5
Liability
• Do you hold anyone responsible?
• Liability is determined by the patient
• Pursuit of dollars is required
6
Liability Misconceptions
• Risk Management Departments
• Letters of protection
• What constitutes a correct answer is subject to
change
7
Commercial Take Backs
• Why does this happen?
• Scenarios
• How are we missing it in the first place?
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Non-Cooperative Patients
• What is a non-cooperative patient?
• Acceptable Documentation
• Common examples
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Medicare Audits
• Accidents
• Improper entitlement identification
• ESRD patients
• Understand the questions you ask
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Speaker Biography
•
Kevin Willis, formerly a National Government Services MSP lecturer and Auditor,
is the Medicare Solutions Director for Claim Services, Inc. Kevin spent ten years
with the Medicare Contractor in the States of Illinois, Indiana, Ohio, and Kentucky.
Four of those years were spent as the Medicare Secondary Payer (MSP) auditor and
educator in those states.
•
Christy Stansfield’s 12 years in the industry started with APS Medical Billing in
2002. In 2005 she joined ProMedica as a Compliance Analyst. She has since risen
to her current title of Acute Care Revenue Cycle Manger from January of 2012 to
present. Her Medicare Secondary Payer expertise has been honed from all
perspectives including a managerial role during an MSP Audit along with all
corrective measure implementation.
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