Medicare Secondary Payer: Proper Claims for Physicians and Hospitals

Event Information
Product Format
Prerecorded Event
90 minutes
Product Description

How the Medicare Secondary Payer (MSP) Program can Impact Your Reimbursements

Medicare Secondary Payer (MSP) involves coordination of benefits and incorrect payments by Medicare, which is significantly confusing. Under MSP, hospitals and physicians must appreciate how the MSP connects with group health insurance, and how the MSP is affected by workers’ compensation payments. You need to understand liability insurance coverage in relation to MSP, appreciate how provider-based clinics can complicate filing claims for MSP, and understand what Medicare does and does not pay as a secondary payer.

Join expert speaker Duane C. Abbey, Ph.D., for a review of the principles of the Medicare secondary payer (MSP) program. Duane will discuss how the MSP connects with group health insurance and is affected by workers’ compensation payments. With this session, you will understand the liability insurance coverage in relation to MSP. This session will help you understand what Medicare does and does not pay as a secondary payer and how provider-based clinics can complicate filing claims for MSP. Duane will discuss the key form locators on the UB-04 and pertinent boxes on the 1500 claim forms. You will be able to work through several case studies involving working aged, disability, workers’ compensation, no-fault liability, and special circumstances. 

The session will review the process of Medicare conditional payment, and the impact of MMSEA Section 111 on MSP. At the end of the session, you will leave with an understanding of possible audits and recoupments including RAC involvement with MSP. You will also understand the need with provider-based clinics to make policy decisions concerning beneficiaries that have Medicare as secondary.

Session Highlights

  • What is the Medicare secondary program?
  • What is the objective of MSP?
  • How is MSP supposed to work?
  • Why is billing MSP so complicated?
  • What process should be used to properly bill Medicare as secondary?
  • How do we handle working aged secondary?
  • Do provider-based clinics create any challenges with MSP?
  • Why is there so much trouble with workers’ compensation?
  • What is a waiver of collection?
  • How does MSP correlate with coordination of benefits contractor (COBC)?
  • How does MMSEA section 111 affect filing MSP claims?
  • What happens if you request and receive conditional payment?
  • To review the key fields on the UB-04 and 1500 claim forms
  • Are the RACs interested in MSP problems?

Session Agenda

  • Review of the  Medicare secondary payer program
    • Basic MSP processes
    • Coverage issues for MSP
    • Rules, regulations and directives
    • Conditional payment process
    • Improper payments
    • Review of CMS guidance for MSP
    • Impact of MMSEA section 111 on MSP
  • MSP relationship to other insurance
    • Group health plans (GHPs)
    • Workers’ compensation claims
    • Liability insurance
    • Special issues
    • Self-insured issues
    • MSP questionnaire and data gathering
  • Medicare payments under MSP
    • Calculating the amount CMS pays for MSP claims
    • Calculating refunds for MSP
      • Conditional payments
      • Group health coverage interfaces
      • Deductibles and coinsurance
    • Interest on MSP recovery claims
  • Case studies – Billing and claims filing
    • Review of pertinent FLs on UB-04 and their values
    • Review of pertinent boxes on the 1500
    • Working aged
    • No-fault liability
    • Workers’ compensation
    • Primary payment in full or contracted amount
    • Provider-based clinics — UB-04 and 1500
    • Disability insurance
    • Public health service
    • Provider-based clinics
  • Regulatory issues
    • Coordination of benefits contractor (COBC)
    • Waiver of collection
    • External audits for MSP compliance
    • RAC and recoupment efforts for MSP
    • Conducting internal audits
    • Section 111 MSP mandatory reporting
  • Sources for research and reference.

Who Should Attend

  • Patient financial services personnel
  • Billing personnel
  • Claims transaction personnel
  • Compliance personnel
  • Utilization review personnel
  • Internal auditing staff
  • Registration personnel
  • Clinical staff
  • All personnel having contact with patients

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

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About Our Speaker

Duane Abbey Hospital Coding & Compliance Expert

 Duane C. Abbey, Ph.D. is a management consultant and president of Abbey & Abbey, Consultants, Inc., which specializes in healthcare consulting and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. He performs various types of financial analysis involving business structuring, organizational development, enrolment and other financially related concerns of organizations....   More Info
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