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Op 'n datum? Hier is hoe om te besluit wie die rekening betaal

Op 'n datum? Hier is hoe om te besluit wie die rekening betaal


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Die antwoord is makliker as wat u sou verwag

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Dit is altyd 'n bietjie ongemaklik om die rekening uit te vind, maar dit hoef nie so te wees nie.

Daar is die ongemaklike oomblik aan die einde van elke eerste afspraak. Jy het klaar jou nagereg en drink die laaste stukkie van jou glas wyn, en die tjek kom aan. Om nie soos 'n goedkoop skate te lyk nie, reik u en u afspraak in u sak of beursie om die ete te betaal.

Maar wie moet die rekening regtig betaal?

Sommige mense sou sê: Haai, dit is 2017! Mans en vroue is gelykes en moet die rekening verdeel, veral as die datum 'n meer informele aangeleentheid is. Sommige mans sou egter in die verleentheid voel as - God verby! - 'n vrou sou die tjek afhaal of selfs probeer om dit te doen. Hy sou daarop aandring om die tjek op te tel en dan 'n ongemaklike oomblik te skep. En as u volgens die outydse reël speel, wie betaal dan vir die rekening op 'n datum van dieselfde geslag?

Die antwoord op enige rekening wat navrae op 'n eerste afspraak betaal, is eintlik baie eenvoudig. Wie die datum begin het, is die een wat moet betaal. Volgens die etiketgids Emily Post, dit is die ware antwoord, en dit maak baie sin as u daaroor nadink.

Die persoon wat die ander op 'n datum gevra het, het tegnies 'n uitnodiging gerig. Hulle het (vermoedelik) die restaurant gekies, so die aand weerspieël hul begeertes: beide wil tyd saam met die ander persoon deurbring en op 'n sekere plek wil eet. En as u genoeg belangstel in iemand om hom te vra, sal u waarskynlik 'n goeie indruk wil maak deur die oortjie te bedek.

As u ongemaklik voel om nie vir aandete op te daag nie, moenie bekommerd wees nie! U kan aanbied om drankies by die kroeg te koop of na die ete vir fliekkaartjies te betaal. En as u wil seker maak dat u 'n goeie indruk op die eerste afspraak maak, klik hier vir wenke.


U faktuurverantwoordelikhede

Om Medicare -programme effektief te laat werk, het verskaffers 'n aansienlike verantwoordelikheid vir die versameling en instandhouding van pasiëntinligting. Hulle moet vrae stel om werk- en versekeringsinligting te verseker. Hulle het die verantwoordelikheid om ander betalers as Medicare te identifiseer, sodat verkeerde faktuur en oorbetalings tot die minimum beperk word. Verskaffers moet bepaal of Medicare die primêre of sekondêre betaler is, daarom moet die begunstigde navraag doen oor ander moontlike dekking wat primêr vir Medicare kan wees. Versuim om 'n stelsel vir die identifisering van ander betalers in stand te hou, word beskou as 'n skending van die verskafferooreenkoms met Medicare.

Verantwoordelikhede van verskaffers onder MSP

As 'n deel A -institusionele verskaffer (dit wil sê hospitale), moet u:

  • Verkry faktuurinligting voordat u hospitaaldienste lewer. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien enige MSP -inligting by die tussenganger in met behulp van toestand- en voorkomskodes op die eis.

As deel B -verskaffer (dws dokters en verskaffers), moet u:

  • Verkry faktuurinligting op die tydstip waarop die diens gelewer word. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien 'n Verduideliking van Voordele (EOB) vorm met alle toepaslike MSP -inligting by die aangewese diensverskaffer in. As u 'n elektroniese eis indien, verskaf die nodige velde, lusse en segmente wat nodig is om 'n MSP -eis te verwerk.

Die CMS -vraelys moet gebruik word om die hoofbetaler van die begunstigde se eise te bepaal. Hierdie vraelys bestaan ​​uit ses dele en bevat vrae aan die begunstigdes van Medicare. Vir institusionele verskaffers, stel hierdie vrae tydens elke binnepasiënt- of polikliniese opname, met die uitsondering van beleide rakende Hospital Reference Lab Services, Recurring Outpatient Services en Medicare+Choice Organization -lede. (Verdere inligting rakende hierdie polisse kan gevind word in Hoofstuk 3 van die MSP Online Manual.) Gebruik hierdie vraelys as 'n gids om ander betalers te identifiseer wat die belangrikste van Medicare kan wees. Aan die begin van Deel 1, vra die pasiënt elke vraag in volgorde. Volg alle instruksies wat op 'n antwoord volg. As die instruksies u lei om na 'n ander deel te gaan, moet die pasiënt elke vraag onder die nuwe deel in volgorde beantwoord. Let wel: Daar kan situasies wees waarin meer as een versekeraar die primêre in Medicare is (bv. Black Lung -program en groepgesondheidsplan). Maak seker dat u alle moontlike versekeraars identifiseer.

Let wel: Daar is programme waaronder betaling vir dienste gewoonlik uitgesluit is van beide primêre en sekondêre Medicare -voordele.

  • Veterane's Administration (VA) Voordele - Medicare betaal nie vir dieselfde dienste wat deur VA -voordele gedek word nie. Kontak die VA-administrasie by 1-800-827-1000 vir meer inligting oor VA-voordele.
  • Federale Black Lung -voordele - Medicare betaal nie vir dienste wat onder die Federal Black Lung -program gedek word nie. As 'n pasiënt wat in aanmerking kom vir Medicare egter 'n siekte of besering het wat nie met swart long verband hou nie, kan die pasiënt 'n eis by Medicare indien. Vir meer inligting, kontak die Federal Black Lung-program by 1-800-638-7072.

Medicare is die sekondêre betaler wanneer begunstigdes:

  • Word behandel vir 'n werkverwante besering of siekte. Medicare kan voorwaardelik betaal vir dienste wat ontvang word vir 'n werksverwante siekte of besering in gevalle waar betaling van die staatswerknemersversekering (WK) nie binne 120 dae verwag word nie. Hierdie voorwaardelike betaling is onderhewig aan herstel deur Medicare nadat 'n WK -skikking bereik is. As WC 'n eis of 'n gedeelte van 'n eis weier, kan die eis by Medicare ingedien word vir oorweging van betaling.
  • Word behandel vir 'n siekte of besering wat veroorsaak word deur 'n ongeluk, en aanspreeklikheids- en/of foutlose versekering dek die mediese uitgawes as primêre betaler.
  • Gedek onder die groepgesondheidsplan (GHP) van hul eie werkgewer of 'n eggenoot.
  • Gestremdes met dekking onder 'n groot groepsgesondheidsplan (LGHP).
  • Gely aan permanente nierversaking (End-Stage Renal Disease) en is binne die koördinasieperiode van 30 maande. Sien ESRD -skakel in die afdeling Verwante skakels hieronder vir meer inligting. Opmerking: Klik op die skakel Medicare Sekondêre Betaler in die afdeling Verwante skakels hieronder vir meer inligting oor wanneer Medicare die sekondêre betaler is.

MSP Aftrededatumbeleid

CMS het 'n operasionele beleid ontwikkel om te help met die verligting van die groot kommer wat hospitale gehad het oor die voltooiing van die CMS -vraelys.

Wat moet gerapporteer word tydens die inname, as 'n begunstigde nie sy/haar presiese aftreedatum of die van sy/haar gade kan onthou as dit vroeër gedek is as afhanklike onder die groepgesondheidsplan van die gade nie?

As 'n begunstigde nie sy/haar aftreedatum kan onthou nie, maar weet dat dit voor sy/haar Medicare -regsdatums plaasgevind het, soos op sy/haar Medicare -kaart aangedui, meld hospitale sy/haar Medicare Part A -datum as aftrede. As die begunstigde afhanklik is van sy/haar eggenoot se groepsgesondheidsversekering en die gade afgetree het voor die begunstigde se Medicare Deel A -aanspreekdatum, meld hospitale die begunstigde se Medicare -aanspraakdatum aan as sy/haar aftreedatum. As die begunstigde verby sy/haar Medicare Deel A -aanspraakdatum gewerk het, gedurende daardie tyd gedek is onder 'n groepsgesondheidsplan, en nie sy presiese datum van aftrede kan onthou nie, maar die hospitaal bepaal dat dit ten minste vyf jaar is sedert die begunstigde afgetree het , skryf die hospitaal die aftreedatum in as vyf jaar terugwerkend op die datum van opname. (Voorbeeld: Hospitale rapporteer die aftreedatum as 4 Januarie 1998, indien die datum van toelating 4 Januarie 2003 is)


U faktuurverantwoordelikhede

Om Medicare -programme effektief te laat werk, het verskaffers 'n aansienlike verantwoordelikheid vir die versameling en instandhouding van pasiëntinligting. Hulle moet vrae stel om werk- en versekeringsinligting te verseker. Hulle het die verantwoordelikheid om ander betalers as Medicare te identifiseer, sodat verkeerde faktuur en oorbetalings tot die minimum beperk word. Verskaffers moet bepaal of Medicare die primêre of sekondêre betaler is, daarom moet die begunstigde navraag doen oor ander moontlike dekking wat primêr vir Medicare kan wees. Versuim om 'n stelsel vir die identifisering van ander betalers in stand te hou, word beskou as 'n skending van die verskafferooreenkoms met Medicare.

Verantwoordelikhede van verskaffers onder MSP

As 'n deel A -institusionele verskaffer (dit wil sê hospitale), moet u:

  • Verkry faktuurinligting voordat u hospitaaldienste lewer. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien enige MSP -inligting by die tussenganger in met behulp van toestand- en voorkomskodes op die eis.

As deel B -verskaffer (dws dokters en verskaffers), moet u:

  • Verkry faktuurinligting op die tydstip waarop die diens gelewer word. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien 'n Verduideliking van Voordele (EOB) vorm met alle toepaslike MSP -inligting by die aangewese diensverskaffer in. As u 'n elektroniese eis indien, verskaf die nodige velde, lusse en segmente wat nodig is om 'n MSP -eis te verwerk.

Die CMS -vraelys moet gebruik word om die primêre betaler van die begunstigde se eise te bepaal. Hierdie vraelys bestaan ​​uit ses dele en bevat vrae wat Medicare -begunstigdes moet vra. Vir institusionele verskaffers, stel hierdie vrae tydens elke binnepasiënt- of polikliniese opname, met die uitsondering van beleide rakende Hospital Reference Lab Services, Recurring Outpatient Services en Medicare+Choice Organization -lede. (Verdere inligting rakende hierdie polisse kan gevind word in Hoofstuk 3 van die MSP Online Manual.) Gebruik hierdie vraelys as 'n gids om ander betalers te identifiseer wat die belangrikste van Medicare kan wees. Begin met Deel 1, en stel die pasiënt elke vraag in volgorde. Volg alle instruksies wat op 'n antwoord volg. As die instruksies u lei om na 'n ander deel te gaan, moet die pasiënt elke vraag onder die nuwe deel in volgorde beantwoord. Let wel: Daar kan situasies wees waarin meer as een versekeraar die primêre in Medicare is (bv. Black Lung -program en groepgesondheidsplan). Maak seker dat u alle moontlike versekeraars identifiseer.

Let wel: Daar is programme waaronder betaling vir dienste gewoonlik uitgesluit is van beide primêre en sekondêre Medicare -voordele.

  • Veterane's Administration (VA) Voordele - Medicare betaal nie vir dieselfde dienste wat deur VA -voordele gedek word nie. Vir meer inligting oor VA-voordele, kontak die VA-administrasie by 1-800-827-1000.
  • Federale Black Lung -voordele - Medicare betaal nie vir dienste wat onder die Federal Black Lung -program gedek word nie. As 'n pasiënt wat in aanmerking kom vir Medicare egter 'n siekte of besering het wat nie met swart long verband hou nie, kan die pasiënt 'n eis by Medicare indien. Vir meer inligting, kontak die Federal Black Lung-program by 1-800-638-7072.

Medicare is die sekondêre betaler wanneer begunstigdes:

  • Word behandel vir 'n werkverwante besering of siekte. Medicare kan voorwaardelik betaal vir dienste wat ontvang word vir 'n werksverwante siekte of besering in gevalle waar betaling van die staatswerknemersversekering (WK) nie binne 120 dae verwag word nie. Hierdie voorwaardelike betaling is onderhewig aan herstel deur Medicare nadat 'n WK -skikking bereik is. As WC 'n eis of 'n gedeelte van 'n eis weier, kan die eis by Medicare ingedien word vir oorweging van betaling.
  • Word behandel vir 'n siekte of besering wat veroorsaak word deur 'n ongeluk, en aanspreeklikheids- en/of foutlose versekering dek die mediese uitgawes as primêre betaler.
  • Gedek onder die groepgesondheidsplan (GHP) van hul eie werkgewer of 'n eggenoot.
  • Gestremdes met dekking ingevolge 'n groot groepsgesondheidsplan (LGHP).
  • Gely aan permanente nierversaking (End-Stage Renal Disease) en is binne die koördinasieperiode van 30 maande. Sien ESRD -skakel in die afdeling Verwante skakels hieronder vir meer inligting. Opmerking: Klik op die skakel Medicare Sekondêre Betaler in die afdeling Verwante skakels hieronder vir meer inligting oor wanneer Medicare die sekondêre betaler is.

MSP Aftrededatumbeleid

CMS het 'n operasionele beleid ontwikkel om te help met die verligting van die groot kommer wat hospitale gehad het oor die voltooiing van die CMS -vraelys.

Wat moet gerapporteer word tydens die inname, as 'n begunstigde nie sy/haar presiese aftreedatum of die van sy/haar gade kan onthou as dit vroeër gedek is as afhanklike onder die groepgesondheidsplan van die gade nie?

As 'n begunstigde nie sy/haar aftreedatum kan onthou nie, maar weet dat dit voor sy/haar Medicare -regsdatums plaasgevind het, soos op sy/haar Medicare -kaart aangedui, meld hospitale sy/haar Medicare Part A -datum as aftrede. As die begunstigde afhanklik is van sy/haar eggenoot se groepsgesondheidsversekering en die gade afgetree het voor die begunstigde se Medicare Deel A -aanspreekdatum, meld hospitale die begunstigde se Medicare -aanspraakdatum aan as sy/haar aftreedatum. As die begunstigde verby sy/haar Medicare Deel A -aanspraakdatum gewerk het, gedurende daardie tyd gedek is onder 'n groepsgesondheidsplan en nie sy presiese datum van aftrede kan onthou nie, maar die hospitaal bepaal dat dit ten minste vyf jaar is sedert die begunstigde afgetree het , skryf die hospitaal die aftreedatum in as vyf jaar terugwerkend op die datum van opname. (Voorbeeld: Hospitale rapporteer die aftreedatum as 4 Januarie 1998, indien die datum van toelating 4 Januarie 2003 is)


U faktuurverantwoordelikhede

Om Medicare -programme effektief te laat werk, het verskaffers 'n aansienlike verantwoordelikheid vir die versameling en instandhouding van pasiëntinligting. Hulle moet vrae stel om werk- en versekeringsinligting te verseker. Hulle het die verantwoordelikheid om ander betalers as Medicare te identifiseer, sodat verkeerde faktuur en oorbetalings tot die minimum beperk word. Verskaffers moet bepaal of Medicare die primêre of sekondêre betaler is, daarom moet die begunstigde navraag doen oor ander moontlike dekking wat primêr vir Medicare kan wees. Versuim om 'n stelsel vir die identifisering van ander betalers in stand te hou, word beskou as 'n skending van die verskafferooreenkoms met Medicare.

Verantwoordelikhede van verskaffers onder MSP

As 'n deel A -institusionele verskaffer (dit wil sê hospitale), moet u:

  • Verkry faktuurinligting voordat u hospitaaldienste lewer. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien enige MSP -inligting by die tussenganger in met behulp van toestand- en voorkomskodes op die eis.

As deel B -verskaffer (dws dokters en verskaffers), moet u:

  • Verkry faktuurinligting op die tydstip waarop die diens gelewer word. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien 'n Verduideliking van Voordele (EOB) vorm met alle toepaslike MSP -inligting by die aangewese diensverskaffer in. As u 'n elektroniese eis indien, verskaf die nodige velde, lusse en segmente wat nodig is om 'n MSP -eis te verwerk.

Die CMS -vraelys moet gebruik word om die hoofbetaler van die begunstigde se eise te bepaal. Hierdie vraelys bestaan ​​uit ses dele en bevat vrae aan die begunstigdes van Medicare. Vir institusionele verskaffers, stel hierdie vrae tydens elke binnepasiënt- of polikliniese opname, met die uitsondering van beleide rakende Hospital Reference Lab Services, Recurring Outpatient Services en Medicare+Choice Organization -lede. (Verdere inligting rakende hierdie polisse kan gevind word in Hoofstuk 3 van die MSP Online Manual.) Gebruik hierdie vraelys as 'n gids om ander betalers te identifiseer wat die belangrikste van Medicare kan wees. Begin met Deel 1, en stel die pasiënt elke vraag in volgorde. Volg alle instruksies wat op 'n antwoord volg. As die instruksies u lei om na 'n ander deel te gaan, moet die pasiënt elke vraag onder die nuwe deel in volgorde beantwoord. Let wel: Daar kan situasies wees waar meer as een versekeraar die primêre in Medicare is (bv. Black Lung -program en groepgesondheidsplan). Maak seker dat u alle moontlike versekeraars identifiseer.

Let wel: Daar is programme waaronder betaling vir dienste gewoonlik uitgesluit is van beide primêre en sekondêre Medicare -voordele.

  • Veterane's Administration (VA) Voordele - Medicare betaal nie vir dieselfde dienste wat deur VA -voordele gedek word nie. Vir meer inligting oor VA-voordele, kontak die VA-administrasie by 1-800-827-1000.
  • Federale Black Lung -voordele - Medicare betaal nie vir dienste wat onder die Federal Black Lung -program gedek word nie. As 'n pasiënt wat in aanmerking kom vir Medicare egter 'n siekte of besering het wat nie met swart long verband hou nie, kan die pasiënt 'n eis by Medicare indien. Vir meer inligting, kontak die Federal Black Lung-program by 1-800-638-7072.

Medicare is die sekondêre betaler wanneer begunstigdes:

  • Word behandel vir 'n werkverwante besering of siekte. Medicare kan voorwaardelik betaal vir dienste wat ontvang word vir 'n werksverwante siekte of besering in gevalle waar betaling van die staatswerknemersversekering (WK) nie binne 120 dae verwag word nie. Hierdie voorwaardelike betaling is onderhewig aan herstel deur Medicare nadat 'n WK -skikking bereik is. As WC 'n eis of 'n gedeelte van 'n eis weier, kan die eis by Medicare ingedien word vir oorweging van betaling.
  • Behandel vir 'n siekte of besering wat veroorsaak word deur 'n ongeluk, en aanspreeklikheid en/of foutlose versekering dek die mediese uitgawes as primêre betaler.
  • Gedek onder die groepgesondheidsplan (GHP) van hul eie werkgewer of 'n eggenoot.
  • Gestremdes met dekking ingevolge 'n groot groepsgesondheidsplan (LGHP).
  • Gely aan permanente nierversaking (End-Stage Renal Disease) en is binne die koördinasieperiode van 30 maande. Sien ESRD -skakel in die afdeling Verwante skakels hieronder vir meer inligting. Opmerking: Klik op die skakel Medicare Sekondêre Betaler in die afdeling Verwante skakels hieronder vir meer inligting oor wanneer Medicare die sekondêre betaler is.

MSP Aftrededatumbeleid

CMS het 'n operasionele beleid ontwikkel om te help met die verligting van die groot kommer wat hospitale gehad het oor die voltooiing van die CMS -vraelys.

Wat moet gerapporteer word tydens die inname, as 'n begunstigde nie sy/haar presiese aftreedatum of die van sy/haar gade kan onthou as dit vroeër gedek is as afhanklike onder die groepgesondheidsplan van die gade nie?

As 'n begunstigde nie sy/haar aftreedatum kan onthou nie, maar weet dat dit voor sy/haar Medicare -regsdatums plaasgevind het, soos op sy/haar Medicare -kaart aangedui, meld hospitale sy/haar Medicare Part A -datum as aftrede. As die begunstigde afhanklik is van die groepsgesondheidsversekering van sy/haar gade en die gade afgetree het voor die begunstigde se mededeling van deel A, rapporteer hospitale die begunstigde se mediese datum as sy/haar aftreedatum. As die begunstigde verby sy/haar Medicare Deel A -aanspraakdatum gewerk het, gedurende daardie tyd gedek is onder 'n groepsgesondheidsplan en nie sy presiese datum van aftrede kan onthou nie, maar die hospitaal bepaal dat dit ten minste vyf jaar is sedert die begunstigde afgetree het , skryf die hospitaal die aftreedatum in as vyf jaar terugwerkend op die datum van opname. (Voorbeeld: Hospitale rapporteer die aftreedatum as 4 Januarie 1998, indien die datum van toelating 4 Januarie 2003 is)


U faktuurverantwoordelikhede

Om Medicare -programme effektief te laat werk, het verskaffers 'n aansienlike verantwoordelikheid vir die versameling en instandhouding van pasiëntinligting. Hulle moet vrae stel om werk- en versekeringsinligting te verseker. Hulle het die verantwoordelikheid om ander betalers as Medicare te identifiseer, sodat verkeerde faktuur en oorbetalings tot die minimum beperk word. Verskaffers moet bepaal of Medicare die primêre of sekondêre betaler is, daarom moet die begunstigde navraag doen oor ander moontlike dekking wat primêr vir Medicare kan wees. Versuim om 'n stelsel vir die identifisering van ander betalers in stand te hou, word beskou as 'n skending van die verskafferooreenkoms met Medicare.

Verantwoordelikhede van verskaffers onder MSP

As 'n deel A -institusionele verskaffer (dit wil sê hospitale), moet u:

  • Verkry faktuurinligting voordat u hospitaaldienste lewer. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien enige MSP -inligting by die tussenganger in met behulp van toestand- en voorkomskodes op die eis.

As deel B -verskaffer (dws dokters en verskaffers), moet u:

  • Verkry faktuurinligting op die tydstip waarop die diens gelewer word. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien 'n Verduideliking van Voordele (EOB) vorm met alle toepaslike MSP -inligting by die aangewese diensverskaffer in. As u 'n elektroniese eis indien, verskaf die nodige velde, lusse en segmente wat nodig is om 'n MSP -eis te verwerk.

Die CMS -vraelys moet gebruik word om die hoofbetaler van die begunstigde se eise te bepaal. Hierdie vraelys bestaan ​​uit ses dele en bevat vrae aan die begunstigdes van Medicare. Vir institusionele verskaffers, stel hierdie vrae tydens elke binnepasiënt- of polikliniese opname, met die uitsondering van beleide rakende Hospital Reference Lab Services, Recurring Outpatient Services en Medicare+Choice Organization -lede. (Verdere inligting rakende hierdie polisse kan gevind word in Hoofstuk 3 van die MSP Online Manual.) Gebruik hierdie vraelys as 'n gids om ander betalers te identifiseer wat primêr vir Medicare kan wees. Begin met Deel 1, en stel die pasiënt elke vraag in volgorde. Volg alle instruksies wat op 'n antwoord volg. As die instruksies u lei om na 'n ander deel te gaan, moet die pasiënt elke vraag onder die nuwe deel in volgorde beantwoord. Let wel: Daar kan situasies wees waarin meer as een versekeraar die primêre in Medicare is (bv. Black Lung -program en groepgesondheidsplan). Maak seker dat u alle moontlike versekeraars identifiseer.

Let wel: Daar is programme waaronder betaling vir dienste gewoonlik uitgesluit is van beide primêre en sekondêre Medicare -voordele.

  • Veterane's Administration (VA) Voordele - Medicare betaal nie vir dieselfde dienste wat deur VA -voordele gedek word nie. Vir meer inligting oor VA-voordele, kontak die VA-administrasie by 1-800-827-1000.
  • Federale Black Lung -voordele - Medicare betaal nie vir dienste wat onder die Federal Black Lung -program gedek word nie. As 'n pasiënt wat in aanmerking kom vir Medicare egter 'n siekte of besering het wat nie met swart long verband hou nie, kan die pasiënt 'n eis by Medicare indien. Vir meer inligting, kontak die Federal Black Lung-program by 1-800-638-7072.

Medicare is die sekondêre betaler wanneer begunstigdes:

  • Word behandel vir 'n werkverwante besering of siekte. Medicare kan voorwaardelik betaal vir dienste wat ontvang word vir 'n werksverwante siekte of besering in gevalle waar betaling van die staatswerknemersversekering (WK) nie binne 120 dae verwag word nie. Hierdie voorwaardelike betaling is onderhewig aan herstel deur Medicare nadat 'n WK -skikking bereik is. As WC 'n eis of 'n gedeelte van 'n eis weier, kan die eis by Medicare ingedien word vir oorweging van betaling.
  • Word behandel vir 'n siekte of besering wat veroorsaak word deur 'n ongeluk, en aanspreeklikheids- en/of foutlose versekering dek die mediese uitgawes as primêre betaler.
  • Gedek onder die groepgesondheidsplan (GHP) van hul eie werkgewer of 'n eggenoot.
  • Gestremdes met dekking ingevolge 'n groot groepsgesondheidsplan (LGHP).
  • Gely aan permanente nierversaking (End-Stage Renal Disease) en is binne die koördinasieperiode van 30 maande. Sien ESRD -skakel in die afdeling Verwante skakels hieronder vir meer inligting. Opmerking: Klik op die skakel Medicare Sekondêre Betaler in die afdeling Verwante skakels hieronder vir meer inligting oor wanneer Medicare die sekondêre betaler is.

MSP Aftrededatumbeleid

CMS het 'n operasionele beleid ontwikkel om te help met die verligting van die groot kommer wat hospitale gehad het oor die voltooiing van die CMS -vraelys.

Wat moet gerapporteer word tydens die inname, as 'n begunstigde nie sy/haar presiese aftreedatum of die van sy/haar gade kan onthou as dit vroeër gedek is as afhanklike onder die groepgesondheidsplan van die gade nie?

As 'n begunstigde nie sy/haar aftreedatum kan onthou nie, maar weet dat dit voor sy/haar Medicare -regsdatums plaasgevind het, soos op sy/haar Medicare -kaart aangedui, meld hospitale sy/haar Medicare Part A -datum as aftrede. As die begunstigde afhanklik is van sy/haar eggenoot se groepsgesondheidsversekering en die gade afgetree het voor die begunstigde se Medicare Deel A -aanspreekdatum, meld hospitale die begunstigde se Medicare -aanspraakdatum aan as sy/haar aftreedatum. As die begunstigde verby sy/haar Medicare Deel A -aanspraakdatum gewerk het, gedurende daardie tyd gedek is onder 'n groepsgesondheidsplan, en nie sy presiese datum van aftrede kan onthou nie, maar die hospitaal bepaal dat dit ten minste vyf jaar is sedert die begunstigde afgetree het , skryf die hospitaal die aftreedatum in as vyf jaar terugwerkend op die datum van opname. (Voorbeeld: Hospitale rapporteer die aftreedatum as 4 Januarie 1998, indien die datum van toelating 4 Januarie 2003 is)


U faktuurverantwoordelikhede

Om Medicare -programme effektief te laat werk, het verskaffers 'n aansienlike verantwoordelikheid vir die versameling en instandhouding van pasiëntinligting. Hulle moet vrae stel om werk- en versekeringsinligting te verseker. Hulle het die verantwoordelikheid om ander betalers as Medicare te identifiseer, sodat verkeerde faktuur en oorbetalings tot die minimum beperk word. Verskaffers moet bepaal of Medicare die primêre of sekondêre betaler is, daarom moet die begunstigde navraag doen oor ander moontlike dekking wat primêr vir Medicare kan wees. Versuim om 'n stelsel vir die identifisering van ander betalers in stand te hou, word beskou as 'n skending van die verskafferooreenkoms met Medicare.

Verantwoordelikhede van verskaffers onder MSP

As 'n deel A -institusionele verskaffer (dit wil sê hospitale), moet u:

  • Verkry faktuurinligting voordat u hospitaaldienste lewer. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien enige MSP -inligting by die tussenganger in met behulp van toestand- en voorkomskodes op die eis.

As deel B -verskaffer (dws dokters en verskaffers), moet u:

  • Verkry faktuurinligting op die tydstip waarop die diens gelewer word. Dit word aanbeveel dat u die CMS -vraelys gebruik (beskikbaar in die afdeling Aflaai hieronder), of 'n vraelys wat soortgelyke vrae stel en
  • Dien 'n Verduideliking van Voordele (EOB) vorm met alle toepaslike MSP -inligting by die aangewese diensverskaffer in. As u 'n elektroniese eis indien, verskaf die nodige velde, lusse en segmente wat nodig is om 'n MSP -eis te verwerk.

Die CMS -vraelys moet gebruik word om die hoofbetaler van die begunstigde se eise te bepaal. Hierdie vraelys bestaan ​​uit ses dele en bevat vrae aan die begunstigdes van Medicare. Vir institusionele verskaffers, stel hierdie vrae tydens elke binnepasiënt- of polikliniese opname, met die uitsondering van beleide rakende Hospital Reference Lab Services, Recurring Outpatient Services en Medicare+Choice Organization -lede. (Verdere inligting rakende hierdie polisse kan gevind word in Hoofstuk 3 van die MSP Online Manual.) Gebruik hierdie vraelys as 'n gids om ander betalers te identifiseer wat die belangrikste van Medicare kan wees. Begin met Deel 1, en stel die pasiënt elke vraag in volgorde. Volg alle instruksies wat op 'n antwoord volg. As die instruksies u lei om na 'n ander deel te gaan, moet die pasiënt elke vraag onder die nuwe deel in volgorde beantwoord. Let wel: Daar kan situasies wees waarin meer as een versekeraar die primêre in Medicare is (bv. Black Lung -program en groepgesondheidsplan). Maak seker dat u alle moontlike versekeraars identifiseer.

Let wel: Daar is programme waaronder betaling vir dienste gewoonlik uitgesluit is van beide primêre en sekondêre Medicare -voordele.

  • Veterane's Administration (VA) Voordele - Medicare betaal nie vir dieselfde dienste wat deur VA -voordele gedek word nie. Kontak die VA-administrasie by 1-800-827-1000 vir meer inligting oor VA-voordele.
  • Federale Black Lung -voordele - Medicare betaal nie vir dienste wat onder die Federal Black Lung -program gedek word nie. As 'n pasiënt wat in aanmerking kom vir Medicare egter 'n siekte of besering het wat nie met swart long verband hou nie, kan die pasiënt 'n eis by Medicare indien. Vir meer inligting, kontak die Federal Black Lung-program by 1-800-638-7072.

Medicare is die sekondêre betaler wanneer begunstigdes:

  • Word behandel vir 'n werkverwante besering of siekte. Medicare kan voorwaardelik betaal vir dienste wat ontvang word vir 'n werksverwante siekte of besering in gevalle waar betaling van die staatswerknemersversekering (WK) nie binne 120 dae verwag word nie. Hierdie voorwaardelike betaling is onderhewig aan herstel deur Medicare nadat 'n WK -skikking bereik is. As WC 'n eis of 'n gedeelte van 'n eis weier, kan die eis by Medicare ingedien word vir oorweging van betaling.
  • Behandel vir 'n siekte of besering wat veroorsaak word deur 'n ongeluk, en aanspreeklikheid en/of foutlose versekering dek die mediese uitgawes as primêre betaler.
  • Gedek onder die groepgesondheidsplan (GHP) van hul eie werkgewer of 'n eggenoot.
  • Gestremdes met dekking onder 'n groot groepsgesondheidsplan (LGHP).
  • Gely aan permanente nierversaking (End-Stage Renal Disease) en is binne die koördinasieperiode van 30 maande. Sien ESRD -skakel in die afdeling Verwante skakels hieronder vir meer inligting. Opmerking: Klik op die skakel Medicare Sekondêre Betaler in die afdeling Verwante skakels hieronder vir meer inligting oor wanneer Medicare die sekondêre betaler is.

MSP Aftrededatumbeleid

CMS het 'n operasionele beleid ontwikkel om te help met die verligting van die groot kommer wat hospitale gehad het oor die voltooiing van die CMS -vraelys.

Wat moet gerapporteer word tydens die inname, as 'n begunstigde nie sy/haar presiese aftreedatum of die van sy/haar gade kan onthou as dit vroeër gedek is as afhanklike onder die groepgesondheidsplan van die gade nie?

As 'n begunstigde nie sy/haar aftreedatum kan onthou nie, maar weet dat dit voor sy/haar Medicare -regsdatums plaasgevind het, soos op sy/haar Medicare -kaart aangedui, meld hospitale sy/haar Medicare Part A -datum as aftrede. If the beneficiary is a dependent under his/her spouse's group health insurance and the spouse retired prior to the beneficiary's Medicare Part A entitlement date, hospitals report the beneficiary's Medicare entitlement date as his/her retirement date. If the beneficiary worked beyond his/her Medicare Part A entitlement date, had coverage under a group health plan during that time, and cannot recall his/her precise date of retirement but the hospital determines it has been at least five years since the beneficiary retired, the hospital enters the retirement date as five years retrospective to the date of admission. (Example: Hospitals report the retirement date as January 4, 1998, if the date of admission is January 4, 2003)


Your Billing Responsibilities

For Medicare programs to work effectively, providers have a significant responsibility for the collection and maintenance of patient information. They must ask questions to secure employment and insurance information. They have a responsibility to identify payers other than Medicare so that incorrect billing and overpayments are minimized. Providers must determine if Medicare is the primary or secondary payer therefore, the beneficiary must be queried about other possible coverage that may be primary to Medicare. Failure to maintain a system of identifying other payers is viewed as a violation of the provider agreement with Medicare.

Responsibilities of Providers Under MSP

As a Part A institutional provider (i.e. hospitals), you should:

  • Obtain billing information prior to providing hospital services. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit any MSP information to the intermediary using condition and occurrence codes on the claim.

As a Part B provider (i.e. physicians and suppliers), you should:

  • Obtain billing information at the time the service is rendered. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit an Explanation of Benefits (EOB) form with all appropriate MSP information to the designated carrier. If submitting an electronic claim, provide the necessary fields, loops and segments needed to process an MSP claim.

The CMS Questionnaire should be used to determine the primary payer of the beneficiary’s claims. This questionnaire consists of six parts and lists questions to ask Medicare beneficiaries. For institutional providers, ask these questions during each inpatient or outpatient admission, with the exception of policies regarding Hospital Reference Lab Services, Recurring Outpatient Services, and Medicare+Choice Organization members. (Further information regarding these policies can be found in Chapter 3 of the MSP Online Manual.) Use this questionnaire as a guide to help identify other payers that may be primary to Medicare. Beginning with Part 1, ask the patient each question in sequence. Comply with all instructions that follow an answer. If the instructions direct you to go to another part, have the patient answer, in sequence, each question under the new part. Note: There may be situations where more than one insurer is primary to Medicare (e.g., Black Lung Program and Group Health Plan). Be sure to identify all possible insurers.

Note: There are programs under which payment for services is usually excluded from both primary and secondary Medicare benefits.

  • Veteran’s Administration (VA) Benefits - Medicare does not pay for the same services covered by VA benefits. For further information about VA benefits, contact the VA Administration at 1-800-827-1000.
  • Federal Black Lung Benefits - Medicare does not pay for services covered under the Federal Black Lung Program. However, if a Medicare-eligible patient has an illness or injury not related to black lung, the patient may submit a claim to Medicare. For further information, contact the Federal Black Lung Program at 1-800-638-7072.

Medicare is the Secondary Payer when Beneficiaries are:

  • Treated for a work-related injury or illness. Medicare may pay conditionally for services received for a work-related illness or injury in cases where payment from the state workers’ compensation (WC) insurance is not expected within 120 days. This conditional payment is subject to recovery by Medicare after a WC settlement has been reached. If WC denies a claim or a portion of a claim, the claim can be filed with Medicare for consideration of payment.
  • Treated for an illness or injury caused by an accident, and liability and/or no-fault insurance will cover the medical expenses as the primary payer.
  • Covered under their own employer’s or a spouse’s employer’s group health plan (GHP).
  • Disabled with coverage under a large group health plan (LGHP).
  • Afflicted with permanent kidney failure (End-Stage Renal Disease) and are within the 30-month coordination period. See ESRD link in the Related Links section below for more information. Note: For more information on when Medicare is the Secondary Payer, click the Medicare Secondary Payer link in the Related Links section below.

MSP Retirement Date Policy

CMS developed an operational policy to help alleviate a major concern that hospitals have had regarding completion of the CMS Questionnaire.

During the intake process, what should be reported 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)?

When a beneficiary cannot recall his/her retirement date, but knows it occurred prior to his/her Medicare entitlement dates, as shown on his/her Medicare card, hospitals report his/her Medicare Part A entitlement date as the date of retirement. If the beneficiary is a dependent under his/her spouse's group health insurance and the spouse retired prior to the beneficiary's Medicare Part A entitlement date, hospitals report the beneficiary's Medicare entitlement date as his/her retirement date. If the beneficiary worked beyond his/her Medicare Part A entitlement date, had coverage under a group health plan during that time, and cannot recall his/her precise date of retirement but the hospital determines it has been at least five years since the beneficiary retired, the hospital enters the retirement date as five years retrospective to the date of admission. (Example: Hospitals report the retirement date as January 4, 1998, if the date of admission is January 4, 2003)


Your Billing Responsibilities

For Medicare programs to work effectively, providers have a significant responsibility for the collection and maintenance of patient information. They must ask questions to secure employment and insurance information. They have a responsibility to identify payers other than Medicare so that incorrect billing and overpayments are minimized. Providers must determine if Medicare is the primary or secondary payer therefore, the beneficiary must be queried about other possible coverage that may be primary to Medicare. Failure to maintain a system of identifying other payers is viewed as a violation of the provider agreement with Medicare.

Responsibilities of Providers Under MSP

As a Part A institutional provider (i.e. hospitals), you should:

  • Obtain billing information prior to providing hospital services. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit any MSP information to the intermediary using condition and occurrence codes on the claim.

As a Part B provider (i.e. physicians and suppliers), you should:

  • Obtain billing information at the time the service is rendered. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit an Explanation of Benefits (EOB) form with all appropriate MSP information to the designated carrier. If submitting an electronic claim, provide the necessary fields, loops and segments needed to process an MSP claim.

The CMS Questionnaire should be used to determine the primary payer of the beneficiary’s claims. This questionnaire consists of six parts and lists questions to ask Medicare beneficiaries. For institutional providers, ask these questions during each inpatient or outpatient admission, with the exception of policies regarding Hospital Reference Lab Services, Recurring Outpatient Services, and Medicare+Choice Organization members. (Further information regarding these policies can be found in Chapter 3 of the MSP Online Manual.) Use this questionnaire as a guide to help identify other payers that may be primary to Medicare. Beginning with Part 1, ask the patient each question in sequence. Comply with all instructions that follow an answer. If the instructions direct you to go to another part, have the patient answer, in sequence, each question under the new part. Note: There may be situations where more than one insurer is primary to Medicare (e.g., Black Lung Program and Group Health Plan). Be sure to identify all possible insurers.

Note: There are programs under which payment for services is usually excluded from both primary and secondary Medicare benefits.

  • Veteran’s Administration (VA) Benefits - Medicare does not pay for the same services covered by VA benefits. For further information about VA benefits, contact the VA Administration at 1-800-827-1000.
  • Federal Black Lung Benefits - Medicare does not pay for services covered under the Federal Black Lung Program. However, if a Medicare-eligible patient has an illness or injury not related to black lung, the patient may submit a claim to Medicare. For further information, contact the Federal Black Lung Program at 1-800-638-7072.

Medicare is the Secondary Payer when Beneficiaries are:

  • Treated for a work-related injury or illness. Medicare may pay conditionally for services received for a work-related illness or injury in cases where payment from the state workers’ compensation (WC) insurance is not expected within 120 days. This conditional payment is subject to recovery by Medicare after a WC settlement has been reached. If WC denies a claim or a portion of a claim, the claim can be filed with Medicare for consideration of payment.
  • Treated for an illness or injury caused by an accident, and liability and/or no-fault insurance will cover the medical expenses as the primary payer.
  • Covered under their own employer’s or a spouse’s employer’s group health plan (GHP).
  • Disabled with coverage under a large group health plan (LGHP).
  • Afflicted with permanent kidney failure (End-Stage Renal Disease) and are within the 30-month coordination period. See ESRD link in the Related Links section below for more information. Note: For more information on when Medicare is the Secondary Payer, click the Medicare Secondary Payer link in the Related Links section below.

MSP Retirement Date Policy

CMS developed an operational policy to help alleviate a major concern that hospitals have had regarding completion of the CMS Questionnaire.

During the intake process, what should be reported 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)?

When a beneficiary cannot recall his/her retirement date, but knows it occurred prior to his/her Medicare entitlement dates, as shown on his/her Medicare card, hospitals report his/her Medicare Part A entitlement date as the date of retirement. If the beneficiary is a dependent under his/her spouse's group health insurance and the spouse retired prior to the beneficiary's Medicare Part A entitlement date, hospitals report the beneficiary's Medicare entitlement date as his/her retirement date. If the beneficiary worked beyond his/her Medicare Part A entitlement date, had coverage under a group health plan during that time, and cannot recall his/her precise date of retirement but the hospital determines it has been at least five years since the beneficiary retired, the hospital enters the retirement date as five years retrospective to the date of admission. (Example: Hospitals report the retirement date as January 4, 1998, if the date of admission is January 4, 2003)


Your Billing Responsibilities

For Medicare programs to work effectively, providers have a significant responsibility for the collection and maintenance of patient information. They must ask questions to secure employment and insurance information. They have a responsibility to identify payers other than Medicare so that incorrect billing and overpayments are minimized. Providers must determine if Medicare is the primary or secondary payer therefore, the beneficiary must be queried about other possible coverage that may be primary to Medicare. Failure to maintain a system of identifying other payers is viewed as a violation of the provider agreement with Medicare.

Responsibilities of Providers Under MSP

As a Part A institutional provider (i.e. hospitals), you should:

  • Obtain billing information prior to providing hospital services. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit any MSP information to the intermediary using condition and occurrence codes on the claim.

As a Part B provider (i.e. physicians and suppliers), you should:

  • Obtain billing information at the time the service is rendered. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit an Explanation of Benefits (EOB) form with all appropriate MSP information to the designated carrier. If submitting an electronic claim, provide the necessary fields, loops and segments needed to process an MSP claim.

The CMS Questionnaire should be used to determine the primary payer of the beneficiary’s claims. This questionnaire consists of six parts and lists questions to ask Medicare beneficiaries. For institutional providers, ask these questions during each inpatient or outpatient admission, with the exception of policies regarding Hospital Reference Lab Services, Recurring Outpatient Services, and Medicare+Choice Organization members. (Further information regarding these policies can be found in Chapter 3 of the MSP Online Manual.) Use this questionnaire as a guide to help identify other payers that may be primary to Medicare. Beginning with Part 1, ask the patient each question in sequence. Comply with all instructions that follow an answer. If the instructions direct you to go to another part, have the patient answer, in sequence, each question under the new part. Note: There may be situations where more than one insurer is primary to Medicare (e.g., Black Lung Program and Group Health Plan). Be sure to identify all possible insurers.

Note: There are programs under which payment for services is usually excluded from both primary and secondary Medicare benefits.

  • Veteran’s Administration (VA) Benefits - Medicare does not pay for the same services covered by VA benefits. For further information about VA benefits, contact the VA Administration at 1-800-827-1000.
  • Federal Black Lung Benefits - Medicare does not pay for services covered under the Federal Black Lung Program. However, if a Medicare-eligible patient has an illness or injury not related to black lung, the patient may submit a claim to Medicare. For further information, contact the Federal Black Lung Program at 1-800-638-7072.

Medicare is the Secondary Payer when Beneficiaries are:

  • Treated for a work-related injury or illness. Medicare may pay conditionally for services received for a work-related illness or injury in cases where payment from the state workers’ compensation (WC) insurance is not expected within 120 days. This conditional payment is subject to recovery by Medicare after a WC settlement has been reached. If WC denies a claim or a portion of a claim, the claim can be filed with Medicare for consideration of payment.
  • Treated for an illness or injury caused by an accident, and liability and/or no-fault insurance will cover the medical expenses as the primary payer.
  • Covered under their own employer’s or a spouse’s employer’s group health plan (GHP).
  • Disabled with coverage under a large group health plan (LGHP).
  • Afflicted with permanent kidney failure (End-Stage Renal Disease) and are within the 30-month coordination period. See ESRD link in the Related Links section below for more information. Note: For more information on when Medicare is the Secondary Payer, click the Medicare Secondary Payer link in the Related Links section below.

MSP Retirement Date Policy

CMS developed an operational policy to help alleviate a major concern that hospitals have had regarding completion of the CMS Questionnaire.

During the intake process, what should be reported 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)?

When a beneficiary cannot recall his/her retirement date, but knows it occurred prior to his/her Medicare entitlement dates, as shown on his/her Medicare card, hospitals report his/her Medicare Part A entitlement date as the date of retirement. If the beneficiary is a dependent under his/her spouse's group health insurance and the spouse retired prior to the beneficiary's Medicare Part A entitlement date, hospitals report the beneficiary's Medicare entitlement date as his/her retirement date. If the beneficiary worked beyond his/her Medicare Part A entitlement date, had coverage under a group health plan during that time, and cannot recall his/her precise date of retirement but the hospital determines it has been at least five years since the beneficiary retired, the hospital enters the retirement date as five years retrospective to the date of admission. (Example: Hospitals report the retirement date as January 4, 1998, if the date of admission is January 4, 2003)


Your Billing Responsibilities

For Medicare programs to work effectively, providers have a significant responsibility for the collection and maintenance of patient information. They must ask questions to secure employment and insurance information. They have a responsibility to identify payers other than Medicare so that incorrect billing and overpayments are minimized. Providers must determine if Medicare is the primary or secondary payer therefore, the beneficiary must be queried about other possible coverage that may be primary to Medicare. Failure to maintain a system of identifying other payers is viewed as a violation of the provider agreement with Medicare.

Responsibilities of Providers Under MSP

As a Part A institutional provider (i.e. hospitals), you should:

  • Obtain billing information prior to providing hospital services. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit any MSP information to the intermediary using condition and occurrence codes on the claim.

As a Part B provider (i.e. physicians and suppliers), you should:

  • Obtain billing information at the time the service is rendered. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit an Explanation of Benefits (EOB) form with all appropriate MSP information to the designated carrier. If submitting an electronic claim, provide the necessary fields, loops and segments needed to process an MSP claim.

The CMS Questionnaire should be used to determine the primary payer of the beneficiary’s claims. This questionnaire consists of six parts and lists questions to ask Medicare beneficiaries. For institutional providers, ask these questions during each inpatient or outpatient admission, with the exception of policies regarding Hospital Reference Lab Services, Recurring Outpatient Services, and Medicare+Choice Organization members. (Further information regarding these policies can be found in Chapter 3 of the MSP Online Manual.) Use this questionnaire as a guide to help identify other payers that may be primary to Medicare. Beginning with Part 1, ask the patient each question in sequence. Comply with all instructions that follow an answer. If the instructions direct you to go to another part, have the patient answer, in sequence, each question under the new part. Note: There may be situations where more than one insurer is primary to Medicare (e.g., Black Lung Program and Group Health Plan). Be sure to identify all possible insurers.

Note: There are programs under which payment for services is usually excluded from both primary and secondary Medicare benefits.

  • Veteran’s Administration (VA) Benefits - Medicare does not pay for the same services covered by VA benefits. For further information about VA benefits, contact the VA Administration at 1-800-827-1000.
  • Federal Black Lung Benefits - Medicare does not pay for services covered under the Federal Black Lung Program. However, if a Medicare-eligible patient has an illness or injury not related to black lung, the patient may submit a claim to Medicare. For further information, contact the Federal Black Lung Program at 1-800-638-7072.

Medicare is the Secondary Payer when Beneficiaries are:

  • Treated for a work-related injury or illness. Medicare may pay conditionally for services received for a work-related illness or injury in cases where payment from the state workers’ compensation (WC) insurance is not expected within 120 days. This conditional payment is subject to recovery by Medicare after a WC settlement has been reached. If WC denies a claim or a portion of a claim, the claim can be filed with Medicare for consideration of payment.
  • Treated for an illness or injury caused by an accident, and liability and/or no-fault insurance will cover the medical expenses as the primary payer.
  • Covered under their own employer’s or a spouse’s employer’s group health plan (GHP).
  • Disabled with coverage under a large group health plan (LGHP).
  • Afflicted with permanent kidney failure (End-Stage Renal Disease) and are within the 30-month coordination period. See ESRD link in the Related Links section below for more information. Note: For more information on when Medicare is the Secondary Payer, click the Medicare Secondary Payer link in the Related Links section below.

MSP Retirement Date Policy

CMS developed an operational policy to help alleviate a major concern that hospitals have had regarding completion of the CMS Questionnaire.

During the intake process, what should be reported 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)?

When a beneficiary cannot recall his/her retirement date, but knows it occurred prior to his/her Medicare entitlement dates, as shown on his/her Medicare card, hospitals report his/her Medicare Part A entitlement date as the date of retirement. If the beneficiary is a dependent under his/her spouse's group health insurance and the spouse retired prior to the beneficiary's Medicare Part A entitlement date, hospitals report the beneficiary's Medicare entitlement date as his/her retirement date. If the beneficiary worked beyond his/her Medicare Part A entitlement date, had coverage under a group health plan during that time, and cannot recall his/her precise date of retirement but the hospital determines it has been at least five years since the beneficiary retired, the hospital enters the retirement date as five years retrospective to the date of admission. (Example: Hospitals report the retirement date as January 4, 1998, if the date of admission is January 4, 2003)


Your Billing Responsibilities

For Medicare programs to work effectively, providers have a significant responsibility for the collection and maintenance of patient information. They must ask questions to secure employment and insurance information. They have a responsibility to identify payers other than Medicare so that incorrect billing and overpayments are minimized. Providers must determine if Medicare is the primary or secondary payer therefore, the beneficiary must be queried about other possible coverage that may be primary to Medicare. Failure to maintain a system of identifying other payers is viewed as a violation of the provider agreement with Medicare.

Responsibilities of Providers Under MSP

As a Part A institutional provider (i.e. hospitals), you should:

  • Obtain billing information prior to providing hospital services. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit any MSP information to the intermediary using condition and occurrence codes on the claim.

As a Part B provider (i.e. physicians and suppliers), you should:

  • Obtain billing information at the time the service is rendered. It is recommended that you use the CMS Questionnaire (available in the Downloads section below), or a questionnaire that asks similar types of questions and
  • Submit an Explanation of Benefits (EOB) form with all appropriate MSP information to the designated carrier. If submitting an electronic claim, provide the necessary fields, loops and segments needed to process an MSP claim.

The CMS Questionnaire should be used to determine the primary payer of the beneficiary’s claims. This questionnaire consists of six parts and lists questions to ask Medicare beneficiaries. For institutional providers, ask these questions during each inpatient or outpatient admission, with the exception of policies regarding Hospital Reference Lab Services, Recurring Outpatient Services, and Medicare+Choice Organization members. (Further information regarding these policies can be found in Chapter 3 of the MSP Online Manual.) Use this questionnaire as a guide to help identify other payers that may be primary to Medicare. Beginning with Part 1, ask the patient each question in sequence. Comply with all instructions that follow an answer. If the instructions direct you to go to another part, have the patient answer, in sequence, each question under the new part. Note: There may be situations where more than one insurer is primary to Medicare (e.g., Black Lung Program and Group Health Plan). Be sure to identify all possible insurers.

Note: There are programs under which payment for services is usually excluded from both primary and secondary Medicare benefits.

  • Veteran’s Administration (VA) Benefits - Medicare does not pay for the same services covered by VA benefits. For further information about VA benefits, contact the VA Administration at 1-800-827-1000.
  • Federal Black Lung Benefits - Medicare does not pay for services covered under the Federal Black Lung Program. However, if a Medicare-eligible patient has an illness or injury not related to black lung, the patient may submit a claim to Medicare. For further information, contact the Federal Black Lung Program at 1-800-638-7072.

Medicare is the Secondary Payer when Beneficiaries are:

  • Treated for a work-related injury or illness. Medicare may pay conditionally for services received for a work-related illness or injury in cases where payment from the state workers’ compensation (WC) insurance is not expected within 120 days. This conditional payment is subject to recovery by Medicare after a WC settlement has been reached. If WC denies a claim or a portion of a claim, the claim can be filed with Medicare for consideration of payment.
  • Treated for an illness or injury caused by an accident, and liability and/or no-fault insurance will cover the medical expenses as the primary payer.
  • Covered under their own employer’s or a spouse’s employer’s group health plan (GHP).
  • Disabled with coverage under a large group health plan (LGHP).
  • Afflicted with permanent kidney failure (End-Stage Renal Disease) and are within the 30-month coordination period. See ESRD link in the Related Links section below for more information. Note: For more information on when Medicare is the Secondary Payer, click the Medicare Secondary Payer link in the Related Links section below.

MSP Retirement Date Policy

CMS developed an operational policy to help alleviate a major concern that hospitals have had regarding completion of the CMS Questionnaire.

During the intake process, what should be reported 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)?

When a beneficiary cannot recall his/her retirement date, but knows it occurred prior to his/her Medicare entitlement dates, as shown on his/her Medicare card, hospitals report his/her Medicare Part A entitlement date as the date of retirement. If the beneficiary is a dependent under his/her spouse's group health insurance and the spouse retired prior to the beneficiary's Medicare Part A entitlement date, hospitals report the beneficiary's Medicare entitlement date as his/her retirement date. If the beneficiary worked beyond his/her Medicare Part A entitlement date, had coverage under a group health plan during that time, and cannot recall his/her precise date of retirement but the hospital determines it has been at least five years since the beneficiary retired, the hospital enters the retirement date as five years retrospective to the date of admission. (Example: Hospitals report the retirement date as January 4, 1998, if the date of admission is January 4, 2003)



Kommentaar:

  1. Farrs

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  2. Dagore

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  3. Gwern

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  4. Mac Alasdair

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  5. Akirr

    Yes, everything makes sense

  6. Efnisien

    Kon jy nie verkeerd gaan nie?



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