Medicare Secondary Payer - Auditing And Monitoring Program Page 3

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MEDICARE SECONDARY PAYER – AUDITING AND MONITORING PROGRAM
Outpatient records by performing the following steps:
a. From the toolbar, select sampling
b. Select Random Sample, records, size of sample (15 is
suggested)
c. Name the Inpatient Medicare records Inpatient_Sample
d. Name the Outpatient Medicare records Outpatient_Sample
6. Submit a request for medical records for the sampled records.
7. Document the procedures in a work paper, including any action plan or
follow up item.
MSP – Testwork
W/P Ref
Initial & Date
Objective:
To determine whether Medicare Inpatient and Outpatient Medicare
Secondary Payer Claims were appropriately billed to Medicare
To determine whether the MSPQ (Medicare Secondary Payer
questionnaires) were completed in accordance with Medicare
Guidelines.
Perform a review of the sampled medical records for Medicare Inpatient
and Outpatient visits by creating a spreadsheet and completing the
following fields.
1. Sample ID
2. Medical Record Number
3. Visit
4. Patient Name
5. Date of Service
6. Mechanism of Injury (if available)
7. Condition Codes
8. Occurrence Codes
9. Admit Date
10. Discharge Date
11. Third Party Coverage requested or reviewed by Admitting?
12. Third Party Coverage provided by patient?
13. Medical Record suggestive of fall or injury?
14. MSPQ completed?
15. Is MSPQ correct? Y/N. If no, brief description/comment.
16. Medicare Primary or Secondary on Account?
17. Medicare billed according to MSPQ guidelines
18. MSP Updated every 60 days if recurring account
19. Other coverage Identified after Medicare billed?
20. Other Coverage Identified?
21. Medicare payment results in a credit balance?
22. Medicare portion of credit balance refunded?
23. Comments
24. Patient Type
25. Exception Repayment Insurer IP (Inpatient)/ OP (outpatient)
26. Repayment Amount
Summarize the findings and amounts to be refunded, if applicable.
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