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Provider Services Bulletin

MSP Retirement Date Policy

The Centers for Medicare & Medicaid Services (CMS) recently developed an operational policy to help alleviate a major concern that hospitals have had regarding completion of the MSP (Medicare Secondary Payer) Hospital Admission Questionnaire:

During the intake process, what should we report when a beneficiary cannot recall his/her precise retirement date or that of his/her spouse if formerly covered as a dependent under the spouse’s group health plan (GHP)? The MSP retirement date policy, which provides details regarding three (3) possible retirement date scenarios, was released on April 25, 2002, to Medicare contractors in the form of manual instructions that updated Section 301 of the Medicare Hospital Manual and Sections 3681.1 and 3693.5 of the Medicare Intermediary Manual. The policy relates to Part IV-Aged-of the MSP Hospital Questionnaire and to the reporting of occurrence codes 18 and 19, which are billed by hospitals to Medicare Part A intermediaries.

If you have any questions about this new MSP operational policy, please call your local intermediary.

Timely Reporting of Employment and Health Insurance Information

Taking time, before a claim is filed, to get information about a beneficiary’s other insurance can save a Medicare provider considerable time in the long run!

The CMS would like to emphasize to providers the importance of reporting timely employment and health insurance information for Medicare beneficiaries for whom services are provided. Based on the law and regulations, providers are required to file correct and accurate claims with Medicare using billing information obtained from the beneficiary to whom the item or service is furnished. Section 1862(b)(6) of the Social Security Act (the Act) (42 USC 1395y(b)(6)) requires all entities seeking payment for any item or service furnished under Part B to complete, on the basis of information obtained from the individual to whom the item or service is furnished, the portion of the claim form relating to the availability of other health insurance. Additionally, 42 CFR 489.20(g) requires that all providers must agree "... to bill other primary payers before billing Medicare ..." Thus, any provider that bills Medicare for services rendered to Medicare beneficiaries must determine whether or not Medicare is the primary payer for those services. This is accomplished by asking Medicare beneficiaries or their representatives, questions concerning the beneficiary’s MSP status. If providers fail to file correct and accurate claims with Medicare, 42 CFR 411.24 permits Medicare to recover its conditional payments.

If you have any questions or concerns regarding the above information, please contact your local Medicare contractor.

Medlearn Matters - Provider Education Articles

Effective February 5, 2004, the CMS implemented an initiative known as "Consistency in Medicare Contractor Outreach" or CMCOM. This initiative provides clear concise instructions to contractors regarding new or changed Medicare policy. Contractors informed their provider communities of this initiative and where this provider outreach material is located. This outreach material is written in provider-friendly language by clinicians and medical coding/billing specialists and posted as articles at www.cms.hhs.gov/Medlearn/Matters. These articles are prepared concurrent with the process for clearing and releasing a related change request (CR) to allow sufficient time to implement.

To continue viewing Provider information on the COB Web site, click here.