Training Programs
Audits & Assessments
Regulatory MonitoringAuthor Archive
This Patient Access Resource Center’s quarterly benchmarking report is designed specifically for patient access managers and finance professionals. This report is based on the results of a survey in which we asked your peers to provide information about their registration accuracy rates.
We wanted to compare the results from our previous survey on registration accuracy back in May 2007.
Here, the good news is that more of your peers are tracking accuracy rates than they were 19 months ago. About 25% of managers said they did not track accuracy rates in May 2007, but only 3% say they do not track rates today.
We suspect that is a direct effect of the CMS Medicare Recovery Audit Contractors (RAC) program, which began its nationwide rollout. The three-year demonstration project collected more than $900 million in overpayments.
Q. Do we include a copy of the Advance Beneficiary Notice (ABN) with the claim form?
A. No, do not submit a copy of the ABN unless requested to do so by the carrier.
Source: Centers for Medicare & Medicaid Services
Effective date: March 13, 2009
Implementation date: March 13, 2009
Medicare is the secondary payor when:
- The patient is 65 or older and the patient or the patient’s spouse is still employed and has insurance through that employer.
- The patient is under 65 and the patient or patient’s spouse is employed by an employer with 100 or more employees and has insurance through that employer.
- The claim is workers’ compensation.
- The claim is a Black Lung claim.
- The claim is a result of an accident and liability insurance is available.
- The claim is for ESRD and the patient is still in the 30-month coordination of benefits period.
Additional MSP tips:
- When Medicare is the secondary payor, the primary payor is #1 in the sequence of payors.
- Medicare is #2 in the sequence of payors when Medicare is the secondary payor.
- MSPs are to be completed on each registration to ensure proper billing.
Editor’s note: Dunn Memorial Hospital in Bedford, IN, uses these hints to help its patient access staff members successfully complete the Medicare Secondary Payer Questionnaire.
The stimulus plan passed by the Senate Tuesday includes millions of dollars for Medicaid, meaning hospitals may see a lift in reimbursements.
The Senate voted to approve an $838 billion economic stimulus plan after the House passed a $820 billion version earlier, The New York Times reported.
“Throughout our history, the federal government has catalyzed a good idea, invested in the ingenuity and entrepreneurship of the American people, and let the private sector flourish,” the majority leader, Senator Harry Reid of Nevada, said before the vote, The New York Times reported. “Faced with an economic crisis today, we have an opportunity to make similar investments that will help our country prosper in the years to come.”
Read the full story in The New York Times.
Medicare is the secondary payor when:
- The patient is 65 or older and the patient or the patient’s spouse is still employed and has insurance through that employer
- The patient is under 65 and the patient or patient’s spouse is employed by an employer with 100 or more employees and has insurance through that employer
- The claim is workers’ compensation
- The claim is a Black Lung claim
- The claim is a result of an accident and liability insurance is available
- The claim is for ESRD and the patient is still in the 30-month coordination of benefits period
Additional MSP tips:
- When Medicare is the secondary payor, the primary payor is first in the sequence of payors
- Medicare is second in the sequence of payors when Medicare is the secondary payor
- MSPs are to be completed on each registration to ensure proper billing
Get blog updates in your e-mail
Subscribe to our free RAC Report e-zine
