COPYRIGHT © 2013 Discovery Health Partners Six questions to determine the health of your Medicare Secondary Payer program.

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Presentation transcript:

COPYRIGHT © 2013 Discovery Health Partners Six questions to determine the health of your Medicare Secondary Payer program

COPYRIGHT © 2013 Discovery Health Partners 2 How many MSP records does your plan have on file with CMS? The lower the better! The number of MSP records as a ratio to your total membership is a key indicator of how well your program is performing. 1

COPYRIGHT © 2013 Discovery Health Partners 3 What percent of attempts to validate other coverage are successful? 2 Are you reaching out to members directly? Instead, contact other insurance and maintain accurate records of the conversation. Case management tools and a contact database of other insurance can help. Don’t settle for less than 100% on every record

COPYRIGHT © 2013 Discovery Health Partners 4 Using ECRS Web (instead of batch updates) to communicate eligibility updates to CMS can result in 30% - 40% higher rate of success restoring premiums. 3 What percent of ECRS submittals are accepted on your first attempt? Aim for 99%

COPYRIGHT © 2013 Discovery Health Partners 5 The positive MSP Adjustment Ratio measures the ratio of positive to negative adjustments due to MSP. The higher this ratio is, the better. What is your Positive MSP Adjustment Ratio? 4

COPYRIGHT © 2013 Discovery Health Partners 6 For payers that offer Medicare Advantage and Commercial coverage – be sure the Commercial plan reports the member’s coverage termination to CMS as soon as the member becomes primary on the Medicare Advantage plan. This will result in maximized premiums and properly paid claims. 5 How does Section 111 reporting impact MSP records reported for your MA membership?

COPYRIGHT © 2013 Discovery Health Partners 7 Are you tracking restoration of premiums due to MSP? Track your success Capture the status of MSP records along the process. This “audit trail” will make it easier to respond to CMS compliance audits, communicate across departments, and reconcile financial impact. 6

COPYRIGHT © 2013 Discovery Health Partners 8 Want to unlock the value of MSP for your organization? Click for more information Restore underpaid premiums and improve efficiency with Discovery Health Partners

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