CMS Updates Questions Providers Should Ask Beneficiaries to Comply with Medicare Secondary Payer Requirements

Medicare; CMS
​On September 15, the Centers for Medicare and Medicaid Services (CMS) published an updated Change Request (CR) transmittal R10359MSP as described in MLN Matters article MM11945 to correct an error in a prior transmittal. The revised version of these questions, which replaces the MSP Admission’s Questionnaire currently in the CMS manual, is found in the updated manual section at the end of R10359MSP. The effective date and implementation date for using these updated questions is December 7, 2020. Provider admission and billing staff should review these changes.     

Background: Providers are required to determine whether Medicare is a primary or secondary payer for each inpatient admission of a Medicare beneficiary and outpatient encounter with a Medicare beneficiary prior to submitting a bill to Medicare. It must accomplish this by asking the beneficiary about other insurance coverage. The model questionnaire in Publication 100-05, Chapter 3, Section 20.2.1 lists the type of questions that should be asked of Medicare beneficiaries for every admission, outpatient encounter, or start of care with exceptions provided. CMS recently re-reviewed the current list of Medicare questions as found in the manual and has decided to update and streamline these questions due to system changes, provider outreach and provider training over the past several years.