Medicare Secondary Payer — A Simple Process with a Big Impact

We’ve heard many organizations say, “We do MSP” or “MSP, it’s easy, we’ve got it covered”. MSP processing may not be rocket science but it’s a regulated process with steps that need to be executed correctly. The MSP transactions that your organization submits directly affect the monthly payment to your Plan and impact your financial reports. Your organization needs to have a confidence level that is equipped with the proper tools to be efficient and compliant, and most importantly feel confident that the financials related to MSP are accurate.

If you‘re uncertain about your end to end process, then you may be missing something and that something could relate to millions of dollars.

Take a moment to review your current process with our MSP Quick Assessment Checklist:

• Tracking Tool: A comprehensive tracking tool is essential for a complete picture of your MSP population and should be:
  • User friendly, efficient and compliant
  • Provide inventory totals of open and closed cases
  • Provide potential A/R of outstanding cases
  • Show case responses (accepted and rejected)
  • Types of outreach performed and number of attempts
  • Dash board reports that provide up to the minute status of cases and financials
  • Flexibility to create customized reports
• Audit Trail
  • An easy way to be CMS compliant is to have an audit trail for each MSP case. Each step of the process, including outreach attempts, follow ups, responses and letters should be documented with a date and time stamp.
• Prioritize your MSP cases for efficiency
  • Group your MSP cases by premium impact or carrier in order to increase efficiency and obtain the best results.
• Persistence
  • One of the most difficult tasks in the MSP process is outreach. Many cases require multiple outreach attempts to carriers or employer groups to obtain validation. Ensure staff is provided proper training and sufficient time to perform outreach and the follow up that’s necessary to resolve cases. Practice due diligence — do not submit cases for “development” as doing so could delay potential recovery for up to 100 days.
• Responses & Rejections
  • Many times organizations fail to review ECRS responses or rejected records. Each rejection code should be reviewed and resubmitted if necessary. Always check your initial submission for keying errors. Don’t miss out on money because you’re failing in this area.
• Communication
  • As a result of an enhancement to ECRS and Part D (4/2012) terminations or delete requests to an MSP occurrence will automatically be applied to a linked drug occurrence record. For example, if a CWF Assistance request is submitted to add a termination date (TD) to an MSP occurrence, the termination date will automatically be applied to the linked drug occurrence. There is no need to submit a separate Prescription Drug Assistance Request. Partner your Part C and Part D areas within your organization to streamline processes, share information and look for efficiencies.

GHG has tools and experienced consultants that can assess your MSP process and provide analytics on your current state process to look for gaps or processes that may be negatively impacting MSP. We can work to create Business Process Redesign plans for a more complete and compliant process.GHG can also provide MSP Analysts to work remotely or onsite for large scale reviews, backlogs, or current work support.

If you’re currently tracking your MSP cases on Excel spreadsheets, then it may be time to set up a demo of GHG’s Valencia— MSP Module. Valencia is the software solution we use when we work with organizations to recover revenue and clean up data.

Resources

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