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 1 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? 8 Non-Cooperative Patients • What is a non-cooperative patient? • Acceptable Documentation • Common examples 9 Medicare Audits • Accidents • Improper entitlement identification • ESRD patients • Understand the questions you ask 10 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. 11