Top 5 Best Practices for MSP Compliance

The toughest part of complying with Medicare Secondary Payer (MSP) rules is understanding the regulations. It can be a tedious, time-consuming, and inefficient process. While MSP is designed to benefit both beneficiaries and Medicare, it can be challenging for the people processing the claims. It involves paying your fair share and reducing out-of-pocket costs, but the process is complex and detailed.

Medicare Coordination of Benefits

Coordination of Benefits (COB) helps Medicare determine payment responsibilities. The Benefits Coordination & Recovery Center (BCRC) oversees all other insurance coverages for Medicare beneficiaries, relying on various databases and accurate information from suppliers.

Let’s review some of the methods used to obtain COB information. Knowing how these methods work will help you ensure that claims are processed correctly and that the appropriate party is billed for the right services.

Initial Enrollment Questionnaire (IEQ)

• Sent about 3 months before entitlement to Medicare.
• Encourages the use of MyMedicare.gov for online access to personal Medicare information.
• Requests completion of the IEQ, which asks about any other health care coverage that may be primary to Medicare.
• Responses are processed to establish if there is other primary insurance or none, recorded in the Common Working File (CWF) MSP Auxiliary Record.

Internal Revenue Service/SSA/CMS Data Match Project

• The IRS/SSA/CMS Data Match Project is a federal requirement for sharing information about Medicare beneficiaries and their spouses among the IRS, SSA, and CMS.
• Employers participate by completing an online Data Match Questionnaire, which asks for information on employees entitled to Medicare or married to a Medicare beneficiary where their employer’s health plan (GHP) might be the primary insurer.
• Employers can also opt for a Voluntary Data Sharing Agreement (VDSA) as an alternative to the questionnaire.

Voluntary Data Sharing Agreement (VDSA)

• Allows for centers for Medicare and Medicaid services and employers to electronically exchange GHP eligibility and Medicare information.
• This includes Medicare Part D prescription drug coverage records.

MSP Mandatory Reporting Process

• Requires additional requirements to GHP, liability, no-fault, and WC insurance plans.
• This reporting is mandatory under section 111.

MSP Claims Investigation

• BCRC investigates missing information on MSP records offering a centralized location for all MSP inquiries.
• These investigations collect data on other health insurance/coverages that may be primary to Medicare.

Electronic Correspondence Referral System (ECRS)

• The ECRS is an online application for Medicare contractors and CMS staff to electronically transmit MSP information to each other.

How to Gather Accurate MSP Data?

One of the hurdles in determining whether Medicare is the primary or secondary payer is obtaining information from the beneficiary. However, as we all know, it’s not a simple task to get information from an individual, especially when they are over the age of 65 and suffering from an illness or injury.

This is why CMS developed the MSP Questionnaire. It’s their way of lending a hand to providers in identifying other payers that may be primary to Medicare. There are 4 parts to this questionnaire:

1. Information about Black Lung Benefits Acts (WC)
   •  Are you receiving benefits under the black lung benefits act?
   • Was the illness/injury due to a work-related accident? Is treatment for a no-fault, liability, or automobile claim?
2. Information about medicare entitlement and group health plans
   • Are you entitled to Medicare?
   • Do you have group health plan (GHP) coverage?
3. Information about the patient if ESRD Medicare Entitlement applies
   • Do you have GHP based on dually entitled disability and ESRD?
   • Have you received a kidney transplant? Dialysis?

For more details on MSP billing requirements and processes related to inpatient/outpatient, workers comp, or GHP read the following document released by the Centers for Medicare and Medicaid Services (CMS)

Medicare Secondary Payer Providers

The responsibilities under MSP provisions are categorized by different providers. Hospitals and Physicians/suppliers. The guidelines for Medicare claims are extensive with the most revised version for MSP providers (issued Feb 23′) being 6 chapters and 48 pages long.

Institutional providers AKA Hospitals:

• Gather accurate MSP data to determine if Medicare is the primary payer by asking the patient, or their representatives for information about GHP coverage.
• Bill the primary payer before billing Medicare as required by the Social Security Act
• Submit MPS information about your Medicare claim using the correct condition and occurrence codes.

Providers AKA Physicians and Suppliers:

• Same as the first two steps for hospitals, gather accurate MSP data to determine if Medicare is the primary payer by asking the patient, or their representatives for information about GHP coverage.
• Bill the primary payer before billing Medicare as required by the Social Security Act.
• Submit an explanation of benefits (EOB) form from the primary payer with your Medicare claim. If submitting an electronic claim provide all necessary fields needed to process an MSP claim.

MSP Tricks of the Trade

Medicare has requirements and regulations for everything from the postal regulations that must be used when developing DNF (do not forward) envelopes to retention periods for which providers must keep health insurance materials. Here we will list ways to ensure compliance and identify areas for improvement within your organization:

1. Compliance Audits: Conduct regular audits of MSP claims handling processes to assess compliance with internal protocols and regulatory requirements. You can follow the manuals posted by the CMS. On their website, they include the most updated audit overviews.
2. Engaging Legal and Compliance Experts: Collaborate with legal and compliance experts who specialize in MSP regulations to ensure accurate interpretation and application of the law. It’s extremely time-consuming reading all compliance manuals but understanding them takes time and practice that most of us and our cases, simply don’t have. Experts can relieve you of compliance, and internal process reviews, and assist in addressing complex MSP issues.
3. Effective Strategies for Verifying Medicare Status: Verify the Medicare status of claimants using strategies like utilizing electronic data sources, obtaining authorization, and asking for copies of Medicare cards.
4. Collaboration with Medicare and the Benefits Coordination and Recovery Center: Follow Section 111 reporting requirements, ensure timely responses to CMS correspondence, and maintain detailed records. The good news is Section 111 is one of the shortest user guides published by CMS, at only 29 pages. Still too long? We thought the same thing.
5. Training and Education for Claims Personnel: Provide comprehensive training and education on MSP regulations, develop internal training programs, and encourage ongoing education. If you don’t have access to an MSP expert then articles like these will help you narrow down resources and compliance rules.

If you’re feeling a bit overwhelmed its normal. Medicare Secondary Payer rules can seem daunting for someone who doesn’t speak the language. If you have any questions relating to the world of MSP or need help on a particularly difficult case get in touch with us today!