Medicare Secondary Payer (MSP) is all about the money.
Money going out as a result of paying claims as primary payer when it’s possible you should be paying as secondary payer. CMS reduces plan payments for members with MSP, shown on the Monthly Membership Report (MMR) as an MSP adjustment (reduction).
Money coming in results when research and outreach attempts validate paying as secondary payer; transactions are submitted to change or delete the occurrence records in Electronic Correspondence Referral System (ECRS). The recovery results are shown as favorable MSP adjustments (increase) in your Monthly Membership Report (MMR) payment. Claims recovery also produces additional revenue.
Medicare Secondary Payer shifts the burden from Medicare to commercial insurance companies. The burden is shifted to both employer plans (Group Health Plans) as well property and casualty insurers (Non-Group Health Plans). For Medicare Advantage plans, MSP is when an employer group sponsored health plan pays primary over the Medicare Advantage plan.
MSP validation is not a one and done process. Information can change, be inaccurate or out of date. Outreach validation requires diligence and persistence. ECRS submissions need to be monitored for non-responses and records under development. Other coverage information and system flags need to be updated for claims reprocessing and recoveries from other insurers for claims that were paid as primary in error.
GHG’s MSP Reconciliation Team has delivered exceptional outcomes for our clients by recouping millions of dollars in MSP recoveries — much more than our clients expected! Each time we’re able to obtain a positive validation and submit a correction to ECRS it means money for the client. That’s a satisfying feeling!
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When it comes to financial reconciliation and overall membership data management, you must protect against leakage. Need help staying ahead of the CMS reconciliation process? GHG will access your member premium revenue, accounts receivable and CMS revenue reconciliation. Visit our website to learn more >>
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