On September 15, 2020, the Centers for Medicare and Medicaid Services (CMS) published changes to the MSP Admissions Questionnaire found in the previous manual.  The changes went into effect on December 7, 2020, and they are designed to modify and streamline the questions that providers should be asking Medicare beneficiaries that they are treating upon the start of care.  

By way of context, the Medicare Secondary Payer Act (MSP) indicates that CMS pays primary unless there is a discrete alternative carrier which should pay primary.  Where there is such an alternative carrier, that carrier pays primary, and where the facts and circumstances give rise to settlement, CMS's interests must be protected. 

What this means from a practical standpoint is that over time CMS has been refining its methods for determining the existence of an alternative payer which should pay primary and whether a settlement has been effectuated such that proceeds from settlement must be exhausted before CMS will pay for related treatment.  While the MSP allows CMS to make provisional payment where such an alternative payer exists, and allows CMS to seek reimbursement for any payments made, recent refinements to CMS policy have been aimed at preventing such provisional payments and therefore avoid the need to seek subsequent reimbursement. 

This is a good thing for CMS because it preserves the Medicare trust fund.  It removes CMS and their recovery contractors from a "pay and chase" scenario and it places a strict requirement on providers to make sure they are asking the right questions to prevent CMS from being billed in the first place.  Overall, if this process is followed consistently, the volume of Medicare conditional payments being made should decrease.  

The questions themselves are geared towards uncovering specific claim/policy numbers and dates of illness/injury such that the provider is able to bill the liability, workers' compensation or no-fault carrier instead of Medicare.  Unfortunately, this line of questions may not prevent Medicare from being billed during the initial visit due to the fact that a claim number is not yet available.  That being said, this should catch most auto and no-fault claims and it may even catch a number of WC claims especially when Medicare beneficiaries change providers.  Further, it will uncover whether Medicare is primary or if another primary payer exists.  

A full list of the new questions can be found here: https://www.cms.gov/files/document/r10359MSP.pdf.

As always, we will continue to provide updates on any changes to CMS's policies that affect the MSP industry.  If you have any questions or concerns about this or any other MSP issues, please contact us at info@allankoba.com.