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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
A consumer group aims to monitor quality of Medicare billing and get rid of waste. But an appeals court won’t let them for now, the Associated Press reports.
A federal appeals court on January 30 overturned the decision to allow the nonprofit Consumers’ Checkbook access to medical billing records under the federal Freedom of Information Act. HHS and the AMA appealed the initial 2007 ruling, and a three-judge panel, in a split decision, reversed the decision.
“The requested data does not serve any (freedom-of-information-related) public interest in disclosure,” Circuit Judge Karen LeCraft Henderson wrote for the majority, the Associated Press reports. “Accordingly, we need not balance the nonexistent public interest against every physician’s substantial privacy interest in the Medicare payments he receives.”
“The majority opinion seems to misunderstand how these data would be used,” Robert Krughoff, president of the consumer group, told the Associated Press. “It doesn’t accurately portray how the data can be used to monitor the quality of healthcare provided under the Medicare program.”
The governor of Minnesota faces a dilemma because of the growing number of Medicaid-eligible patients in his state, the Minneapolis Star Tribune reports.
Governor Tim Pawlenty’s budget includes a $3 billion share for Medicaid, which is one-fifth of his budget. But cutting isn’t easy. He has a Legislature that wants to expand access to healthcare for the poor.
Read the full story in the Tribune.
Within days of taking office, President Barack Obama plans to rescind a Bush administration policy that has impeded state efforts to provide health insurance to children from low- and middle-income families through the State Children’s Health Insurance Program (SCHIP), aides and advisers announced. The policy is one of many that the new administration hopes to change or withdraw in its first weeks in office.
Obama has said, for example, that he objects to a Bush administration rule that grants sweeping new protections to health workers who refuse to provide care because of their “religious beliefs or moral convictions.”
Read the full story in The New York Times.
York (ME) Hospital finds bedside registration in the emergency department one of the most effective tools to ensure an accurate and compliant patient claim.
Pat Finnemore, CHAA, who works on the patient access team at the 11-bed ED facility, says bedside registration in the ED:
- Increases efficiency of workload for registrars
- Opens strong lines of communication between clinical and access teams
- Provides convenience for patients who do not want to be shuffled from place to place.
“We have not found this process to be more difficult at all,” Finnemore says. “We have an excellent working relationship with the clinical staff. Patients also like not being shuffled around. They can get in and get comfortable.”
Massachusetts Gov. Deval Patrick has asked the state’s most prominent hospital and health insurance leaders to take quick action to hold down rapidly rising healthcare costs, suggesting that if they did not take steps on their own, they might face new government regulation, according to the Boston Globe.
Patrick said he is considering holding hearings on health insurance premiums and the primary driver of premium increases—the rates hospitals charge insurers for members’ medical care. He has also said the state Division of Insurance has the power to reject rates it deems excessive.
Read the full story in the Boston Globe.
Health insurer WellPoint Inc. has been barred from adding customers to Medicare plans after it denied prescription drugs to the elderly, endangering their lives, the government recently announced. The sanctions, outlined in a letter to WellPoint from CMS, followed a “sharp” increase in consumer complaints.
Elderly customers were stopped from receiving essential prescription drugs, and some were overcharged because of computer mistakes, according to the government.
Read the full story in the Los Angeles Times.
Americans spent only 0.2% more on healthcare in 2006 than they did the year before, triggering the slowest growth grate since 1999. The average American spends $7,421 on healthcare, according to a report by CMS.
“This is another reminder that the cost of healthcare continues to be a real and pressing concern facing the American public and the federal government,” said CMS Acting Administrator Kerry Weems in a statement. “This report–like the reports issued last year on the financial status of Medicare and Medicaid–is a stark reminder that we must redouble our ongoing efforts to reform the delivery of healthcare services in this country to bring about the goal of affordable, high quality health for all Americans.”
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