Medicare Secondary Payer (MSP) is the term used when Medicare is not the primary paying party. Heartache swirls around MSP claims for a variety of reasons, mainly because these claims are complex, need manual work and take the time from your busy billing team that it doesn’t have.
As with most claims, a successful path to reimbursement begins at intake. It’s the provider’s responsibility to determine who is the primary payer. This requires a system to accurately verify a patient’s coverage and eligibility status. Different factors determine if Medicare is the primary payer, including the beneficiary’s age, employment (or spousal employment) status, size of the employer and if the patient has certain medical conditions.
Since it’s your responsibility as the provider to determine if a Medicare is truly the secondary payer, you must follow rules to obtain MSP information. You must also use correct MSP coding on claims:
- MSP Type
- Working Aged
- End Stage Renal Disease
- Conditional Payment
- Worker’s Comp/Worker’s Comp Set Aside
- Federal Black Lung
- Dollar Amounts
- Value Codes
- Occurrence Codes
- Claim Adjustment Reason Codes (CARCS)
Why do MSP claims create so many headaches for Home Health and Hospice agencies? First, if you failed to determine correct coverage and billed Medicare for a claim that should have been billed as an MSP claim, the claim will go into Return to Provider (RTP) status or rejected altogether. Many providers don’t have the claim reporting tools to help them discover or manage RTP claims. An RTP claim requires attention, or you’re leaving money on the table. Once you get an RTP on an MSP claim, you must rebill the claim to the primary payer, which takes extra time and effort.
Second, when a primary payer pays the MSP claim, it may not cover all the charges. This means you can now bill Medicare for the remaining charges. The only way to bill the remaining charges is through manual entry in the DDE or via paper, both costly activities for busy agencies. This is a highly cumbersome process, leading many agencies to simply write off what’s left on these claims.
Win the MSP Claim Battle
How does your agency bill, track, find and recover MSP claims while avoiding the cost of manually handling them? eSolutions has the only tool in the marketplace featuring built-in functionality for easily billing MSP claims with the Medicare Enterprise package.
The claim editor in Medicare Enterprise intuitively leads you through billing an MSP claim in a familiar UB-04 environment. Simply choose Medicare Secondary Payer as the claim type and Medicare Enterprise automatically provides all the claim fields you need to complete, including claim adjustments.
Medicare Enterprise also gives you a snapshot of which claims are in RTP status because they were incorrectly billed to Medicare when they should have been billed to the primary payer first. You can work these claims straight from the Medicare Enterprise reporting interface by editing a previous claim or creating a new one.
It’s not uncommon for our home health and hospice clients to refuse admitting a patient who has a secondary payer because the billing process is too costly, said James Ryan, eSolutions Vice-President of Sales. We’ve helped many agencies conquer the pains of billing MSP claims so they are now recouping thousands of dollars rightfully owed to them.
St. Anthony’s Hospice Director of Operations, Jodie Conrad, said using eSolutions’ Medicare Enterprise has helped the hospice recover serious chunks of revenue they otherwise had never received. Using eSolutions products, we got paid on our first MSP claim ever, Jodie said. With billing three to five MSP claims a year, eSolutions more than paid for itself.
Your agency is not alone in trying to effectively battle MSP claims so you can recover money that belongs to you. Give Medicare Enterprise a try to see how it can solve your MSP claim issues. Connect with our Home Health and Hospice experts for a demo or test-drive your own data with a 30-day no-risk trial.