{"id":988,"date":"2022-05-27T11:42:12","date_gmt":"2022-05-27T11:42:12","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/dme-billing-services-blog\/?p=988"},"modified":"2022-08-10T17:19:15","modified_gmt":"2022-08-10T17:19:15","slug":"questionnaire-to-decide-medicare-secondary-payer-msp","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/dme-billing-services-blog\/questionnaire-to-decide-medicare-secondary-payer-msp\/","title":{"rendered":"Questionnaire to Decide Medicare Secondary Payer (MSP)"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">The following questionnaire contains questions that can be used to ask Medicare beneficiaries upon each inpatient and outpatient admission. Providers may use this as a guide to help identify other payers that may be primary to Medicare. This questionnaire is a model of the type of questions that may be asked to help identify Medicare Secondary Payer (MSP) situations. If you choose to use this questionnaire, please note that it was developed to be used in sequence. Instructions are listed after the questions to facilitate the transition between questions. The instructions will direct the patient to the next appropriate question to determine Medicare Secondary Payer situations.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Part 1<\/span><\/h2>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are you receiving Black Lung (BL) Benefits? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">. In this case, BL is the primary payer only for claims related to BL<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are the services to be paid for by a government research program? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">. In this case, the government research program will pay primary benefits for these services.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Has the Department of Veterans Affairs (DVA) authorized and agreed to pay for your care at this facility? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">. In this case, DVA is primary for these services.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Was the illness\/injury due to a work-related accident\/condition? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">. In this case, WC is the primary payer only for claims for work-related injuries or illness, go to part 3.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">. Go to part 2<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<h2><span style=\"font-weight: 400;\">Part 2<\/span><\/h2>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Was illness\/injury due to a non-work-related accident? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">. Go to part 3.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Is liability insurance available? (Liability insurance is insurance that protects against claims based on negligence, inappropriate action, or inaction, which results in injury to someone or damage to property.) <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">. A no-fault insurer is a primary payer only for those services related to the accident. Liability insurance is the primary payer only for those services related to the liability settlement, judgment, or award. Go to part 3.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<h2><span style=\"font-weight: 400;\">Part 3<\/span><\/h2>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are you entitled to Medicare based on:<\/span>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Age<\/span><\/i><span style=\"font-weight: 400;\">; Go to part 4.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Disability<\/span><\/i><span style=\"font-weight: 400;\">; Go to part 5.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">End-Stage Renal Disease (ESRD)<\/span><\/i><span style=\"font-weight: 400;\">; Go to part 6.\u00a0<\/span><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Please note that both \u2018Age\u2019 and \u2018ESRD\u2019 or \u2019Disability\u2019 and \u2018ESRD\u2019 may be selected simultaneously. An individual cannot be entitled to Medicare based on \u2018Age\u2019 and \u2018Disability\u2019 simultaneously.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Part 4: Age<\/span><\/h2>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are you currently employed? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you have a spouse who is currently employed?<\/span><i><span style=\"font-weight: 400;\"> (Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">If the patient answered \u2018<\/span><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">\u2019 to questions 1 and 2, then Medicare is primary unless the patient answered \u2018<\/span><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">\u2019 to questions in parts 1 and 2. Do not proceed further.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you have group health plan (GHP) coverage based on your own or a spouse&#8217;s current employment? (<\/span><i><span style=\"font-weight: 400;\">Yes, both\/Yes, self\/Yes, spouse\/No<\/span><\/i><span style=\"font-weight: 400;\">)<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">. STOP. Medicare is the primary payer unless the patient answered \u2018<\/span><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">\u2019 to the questions in parts 1 or 2.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you have GHP coverage based on your own current employment, does your employer that sponsors or contributes to the GHP employ 20 or more employees? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">. GHP is primary.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you have GHP coverage based on your spouse\u2019s current employment, does your spouse\u2019s employer, which sponsors or contributes to the GHP, employ 20 or more employees?<\/span><i><span style=\"font-weight: 400;\"> (Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">. GHP is primary.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">. If the patient answered \u2018<\/span><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">\u2019 to both questions 4 and 5, Medicare is primary unless the patient answered \u2018<\/span><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">\u2019 to questions in the past 1 or 2.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<h2><span style=\"font-weight: 400;\">Part 5: Disability<\/span><\/h2>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are you currently employed? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you have a spouse who is currently employed? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you have group health plan (GHP) coverage based on your own or a spouse\u2019s current employment? (<\/span><i><span style=\"font-weight: 400;\">Yes, both\/Yes, self\/Yes, spouse\/No<\/span><\/i><span style=\"font-weight: 400;\">)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are you covered under the GHP of a family member other than your spouse? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">If the patient answered \u2018<\/span><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">\u2019 to questions 1,2,3 and, 4. STOP. Medicare is primary unless the patient answered \u2018<\/span><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">\u2019 to questions in part 1 or 2.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you have GHP coverage based on your own current employment, does your employer that sponsors or contributes to the GHP employ 100 or more employees? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes.<\/span><\/i><span style=\"font-weight: 400;\"> GHP is primary.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you have GHP coverage based on your spouse\u2019s current employment, does your spouse\u2019s employer, which sponsors or contributes to the GHP, employ 100 or more employees?<\/span><i><span style=\"font-weight: 400;\"> (Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes.<\/span><\/i><span style=\"font-weight: 400;\"> GHP is primary.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you have GHP coverage based on a family member\u2019s current employment, does your family member\u2019s employer, that sponsors or contributes to the GHP, employ 100 or more employees? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes.<\/span><\/i><span style=\"font-weight: 400;\"> GHP is primary.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No.<\/span><\/i><span style=\"font-weight: 400;\"> If the patient answered \u2018<\/span><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">\u2019 to questions 5,6 and 7, Medicare is primary unless the patient answered \u2018Yes\u2019 to questions in parts 1 or 2.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<h2><span style=\"font-weight: 400;\">Part 6: ESRD<\/span><\/h2>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you have group health plan (GHP) coverage? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes. <\/span><\/i><span style=\"font-weight: 400;\">If applicable, get (patient\u2019s and spouse\u2019s\/ family member\u2019s) GHP information<\/span><i><span style=\"font-weight: 400;\">.<\/span><\/i><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">. STOP. Medicare is primary.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are you within the 30-month coordination period that starts MM\/DD\/CCYY? (The 30-month coordination period starts the first day of the month an individual is eligible for Medicare (even if not yet enrolled in Medicare) because of kidney failure (usually the fourth month of dialysis). If the individual is participating in a self-dialysis training program or has a kidney transplant during the 3- month waiting period, the 30-month coordination period starts with the first day of the month of dialysis or kidney transplant.) <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No. <\/span><\/i><span style=\"font-weight: 400;\">STOP<\/span><i><span style=\"font-weight: 400;\">. <\/span><\/i><span style=\"font-weight: 400;\">Medicare is primary.<\/span><i><span style=\"font-weight: 400;\">\u00a0<\/span><\/i><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Was your initial entitlement to Medicare (including simultaneous or dual entitlement) based on ESRD?<\/span><i><span style=\"font-weight: 400;\"> (Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">. STOP. GHP continues to pay primary during the 30-month coordination period.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">. Initial entitlement is based on \u2018Age\u2019 or \u2018Disability\u2019.<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Does the working-aged or disability Medicare Secondary Payer provision apply (i.e., is the GHP already primary based on age or disability entitlement)? <\/span><i><span style=\"font-weight: 400;\">(Yes\/No)<\/span><\/i>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">Yes<\/span><\/i><span style=\"font-weight: 400;\">. GHP continues to pay primary during the 30-month coordination period.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><i><span style=\"font-weight: 400;\">No<\/span><\/i><span style=\"font-weight: 400;\">. Medicare continues to pay primary.\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">We shared a questionnaire to be asked to Medicare beneficiaries while admitted to deciding on Medicare Secondary Payer (MSP). You can refer <\/span><a href=\"https:\/\/www.cms.gov\/Medicare\/Coordination-of-Benefits-and-Recovery\/ProviderServices\/Downloads\/CMS-Questionnaire.pdf\"><span style=\"font-weight: 400;\">CMS document<\/span><\/a><span style=\"font-weight: 400;\"> for detailed information. <\/span><a href=\"https:\/\/www.medicalbillersandcoders.com\/\"><b>Medical Billers and Coders (MBC)<\/b><\/a><span style=\"font-weight: 400;\"> is a leading medical billing company providing complete revenue cycle services. Our billing services include benefits verification, charge entry, payment posting, denial management, AR management, provider enrollment, provider credentialing, and many other RCM services. If you are looking for any assistance in medical billing for your practice, contact us at <a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a>\/ <a href=\"tel: 888-357-3226\">888-357-3226<\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The following questionnaire contains questions that can be used to ask Medicare beneficiaries upon each inpatient and outpatient admission. Providers may use this as a guide to help identify other payers that may be primary to Medicare. This questionnaire is a model of the type of questions that may be asked to help identify Medicare [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1000,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[304,301,302,109,299,85,148,298,294,297,303,295,305,296,300],"class_list":["post-988","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing","tag-ar-management","tag-benefits-verification","tag-charge-entry","tag-denial-management","tag-leading-medical-billing-company","tag-medical-billing-services","tag-medicare","tag-medicare-beneficiaries","tag-medicare-secondary-payer","tag-medicare-secondary-payer-msp","tag-payment-posting","tag-provider-credentialing","tag-provider-enrollment","tag-rcm-services","tag-revenue-cycle-services"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.1 - 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