Questionnaire to Decide Medicare Secondary Payer (MSP)

Medicare enrollees can use the following form to ask questions at the time of each inpatient and outpatient stay. This can be used as a reference by providers to find additional payers who might be Medicare’s primary. This survey serves as an example of the kinds of inquiries that could be made in order to determine Medicare Secondary Payer (MSP) circumstances. Please be aware that this questionnaire was designed to be completed in a specific order if you decide to use it. To make the transition between questions easier, instructions are included after each question. The patient will be guided by the instructions to the next suitable inquiry in order to ascertain their Medicare Secondary Payer circumstances.

Part : 1

Do you get benefits for Black Lung (BL)? (Alright/Alright)
Indeed. In this instance, BL is the exclusive primary payer for claims pertaining to BL.

Is a government research program going to cover the cost of the services? (Alright/Alright)
Indeed. In this instance, the primary benefit for these services will be funded by the government research program.

Has your treatment at this hospital been approved and approved by the Department of Veterans Affairs (DVA)? (Alright/Alright)
Indeed. For these services, DVA is in charge in this instance.

Was there an accident or circumstance at work that caused the illness or injury? (Alright/Alright)
Indeed. For claims pertaining to illnesses or injuries sustained at work, WC is the primary payer in this instance; proceed to part 3.

No. Proceed to Part 2

Part : 2

Was the illness/injury brought on by an incident unrelated to work? (Alright/Alright)
No. Proceed to section 3.

Is it possible to get liability insurance? (Liability insurance is insurance that defends against claims based on carelessness, inappropriate behavior, or inaction that causes property damage or personal injury.) (Alright/Alright)
No. The principal payment for services linked to the accident is simply the no-fault insurer. Only services connected to the liability settlement, judgment, or award are covered by liability insurance as the principal payer. Proceed to section 3.

Part : 3

Do you qualify for Medicare depending on your age? Proceed to section 4.

Impairment; go to section 5. End-Stage Renal Disease (ESRD); proceed to section 6.
Note that you may pick “Age” and “ESRD” or “Disability” and “ESRD” at the same time. Medicare cannot be granted to a person on the basis of both “disability” and “age” at the same time.

Part : 4 Age

Do you have a job right now? (Alright/Alright)
Does your spouse currently work somewhere? (Alright/Alright)Medicare takes precedence if the patient responded “No” to sections 1 and 2, unless they responded “Yes” to those questions. Don’t carry on.
Because of your present employment or the employment of your spouse, do you have group health plan (GHP) coverage? (True, both/True, oneself/True, spouse/No)
No. QUIT. Unless the patient indicated in part 1 or part 2 that they answered “Yes,” Medicare is the primary payer.
Does your employer that sponsors or contributes to the GHP employ 20 or more people, if you are covered by the program through your current employment? (Alright/Alright)
Indeed. GHP is the main one.
If you’re covered by GHP

We provided a survey that Medicare enrollees would be required to complete in order to select a Medicare Secondary Payer (MSP). For more details, see the CMS document. One of the top medical billing companies offering full revenue cycle services is Medical Billers and Coders (MBC). In addition to many other RCM services, our billing services include benefits verification, charge entry, payment posting, rejection management, AR management, provider registration, and provider credentialing.