MSPQ
When does the MSPQ need to be filled out?
Every visit where MCR is billed, primary and secondary
If the pt is 65 and older, is working, has a GHP and has less than 20 employees, who is primary?
MCR if less than 20 employees
Name 3 MSP Value code #s and their title.
12 - WA, 13-ESRD, 41-Black Lung, 43 - Disabled
14- Auto, 15-WC, 16-Other Federal, 47-Liability
Primary processed with CARC CO97 and secondary MCR is hitting an edit for this, how do I fix?
CARC CO97 not allowed, roll this balance into the CO45 adjustment
What does BCRC stand for?
Benefits Coordination and Recovery Center
When would it be appropriate to not fill out a MSPQ?
When we are billing a pts HMO replacement plan
If the pt has ESRD, and is in the first 30 mos of ESRD eligibility/entitlement, has a GHP, who is primary?
If with in the first 30 mos, GHP is primary
If the primary payors less than the allowed amt and has applied a PR balance, what code would be required to denote this?
Value Code 44 - primary payment + patient responsibility
Medicare paid as primary, CWF updated and now are secondary and a XX7 is needed, what CC would I use?
Condition Code D7
What is Medicare?
Medicare is an entitlement program designed to cover medical expenses for eligible U.S. residents.
For recurring outpatient services, how long is a MSPQ valid for before we must fill another out for the recurring services only?
90 days
If a pt is 65 and older and on employer retirement plan, who is primary?
MCR primary, retiree coverage pays 2ndary
If the primary paid $0 and applied a balance to PR, what code would we use to denote this?
Occurrence Code 24
If claim rejects for Work Comp is primary, what would be your steps to resolution?
1.) determine if related to Work Comp or not
2.) If not, add remarks and bill MCR, if related, bill Work Comp
When did Medicare begin?
1966 - founded in 1965
For the MSPQ, if the pt cannot remember their retirement date, but knows it was prior to MCR entitlement, what would we use?
Use the effective date of Part A coverage
If the pt is 65 and older, has COBRA, who is primary?
MCR is primary
When a PT has ESRD what additional codes are required?
VC 13 requires Occurence Code 33 - date the ESRD period began, can only locate this is by running eligibility in DDE or WayStar.
If the primary CARC codes contain OA and hitting an edit, how do we resolve?
OA cannot be submitted to 2ndary, this is rolled into the CO45 adjustment.
What is Dual Entitlement?
Anytime an individual is entitled to Medicare for two different reasons, they are considered dually entitled
If the pt is retired and continued working beyond Part A entitlement date, and the pt cannot remember retirement date, what date would we use?
If its been at least 5 years, use the date of admission. If less than 5, hospital must obtain the retirement date from employer or patient.
If the pt has ESRD, has COBRA coverage, and is in the first 30 mos. of entitlement to MCR, who is primary?
COBRA till end of 30 mos
TOB : 111
CC 77, VC 80 with appropriate days
Remarks: NO PT RESPONSIBILITY BILLING TO RPT DAYS
MSPQ VCs (driven from MSPQ)
If the VCs aren't dropping on the claim to MCR 2ndary, what can I do?
EPIC automates these codes, if they are not on the MCR 2ndary claim, that means your MSPQ is incorrect. Do not add these to claim info (unless needing to update $ amt on VC)
If a patient has taken a Vow of Poverty with their employer, and has Medicare, who is primary?
Ex: Nuns, Priests, Medicare is primary