Medicare Compliance & Reimbursement

LABS:

Providers Must Stay Posted On MSP Changes

Modifications could severely affect secondary payer rules.

The last thing a lab needs is to be singled out by the Centers for Medicare and Medicaid Services for sloppy Medicare secondary payer (MSP) collection practices.

The Medicare Modernization Act (MMA) changed the rules for what labs must collect, but the new guidance doesn't affect face-to-face encounters, such as when a client shows up for her thyroid screen.

Before a lab launches into a service, it must determine whether the patient has an insurance option outside of Medicare, says Lisa Lounsbury, a data analyst with the Vascular Diagnostics Laboratory at Fletcher Allen Health Care in Burlington, VT.

Best bet: Use a questionnaire to cover all potential payment bases, suggests Lena Robins, senior counsel with Foley & Lardner in Washington, DC. Labs can either create their own forms or use the one CMS provides. Labs should keep these questions in mind when creating custom MSP forms:
 
  • Are you currently employed?
     
  • Is your spouse currently employed?
     
  • Is your visit due to a work-related illness or injury that's covered by Workers' Compensation?
     
  • Is your visit due to an illness or injury covered by auto insurance, no-fault insurance, medical payments coverage, personal injury insurance, liability insurance or a legal settlement?
     
  • Do you have an illness or injury for which someone else could be held liable?
     
  • Do you receive Black Lung Program benefits?
  • Other Articles in this issue of

    Medicare Compliance & Reimbursement

    View All