Medicare Secondary Payer (MSP)

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CMS Quality Measurements Projects and the Goals

CMS is presently developing outcome core measures that are patient oriented and cross providers setting during the continuum of care.

AHCA Home Care Unit

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The worst disservice a clinician can do their patient and employer is not to use critical thinking when developing, implementing, revising the patient's Plan of Care, see "Using "Critical Thinking" during clinical practice..."

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Medicare Secondary Payer (MSP)

Is Medicare responsible to pay the home health bill when a patient suffers an injury and anotherr payer is covering the expences? The answer is complex and it has a high potential for delaying the release of the final bill to Medicare, see MSP.

To pay or not to pay it's the question from Medicare. That is the reason why we need to complete an MSP on SOC. There seem to be a lack of understanding by the clinicians on why and how the MSP must be completed accurately. CMS needs to make sure that Medicare dollars are not being spend inappropriately by identifying who is responsible for paying for the home health bill when a patient suffers an injury as in a car accident or liability related to a fall in a restaurant or has a chronic illness like dialysis.

CMS billing system has many ways to identify if there is another potential payor. One of them is by the ICD-9 code use in the bill. If CMS identifies another possible payer the home care agency payment for the RAP/Final Bill will be place on hold until the home care agency biller provides the require information that was collected on the MSP during the admission process.

When the MSP is not completed correctly or not completed at all it will impact the billing process by delaying reimbursement from CMS.  Ensure that the organization have a process to ensure all MSPs are completed correctly at SOC, for more information on the MSP see