Author Topic: Medicare Secondary Payment Adjustment Information  (Read 1772 times)


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Medicare Secondary Payment Adjustment Information
« on: July 06, 2013, 09:09:23 AM »
Medicare Secondary Payment Adjustment Information
CMS was notified on March 20, 2013 of an error in the Fiscal Intermediary Shared System (FISS) that caused the Medicare Secondary Payment (MSP) full recovery indicator to set incorrectly when the primary payer payment was not greater than:
•   the obligated to accept as payment in full (OTAF) amount,
•   the Medicare covered charges, or
•   Medicare reimbursement amount.
As a result, the MSPPAY module zeroed out coinsurance days as part of its calculation; also, some claims were processed incorrectly as “full recovery” claims that reflected zero Medicare payment. Medicare secondary payments should have been made for both institutional Part A and Part B provider claims.
On May 6, 2013, FISS was updated to apply the OTAF amount and full recovery indicator correctly. This fix also allows the system to correctly identify this MSP savings type as a “full recovery” when claims meet all the criteria for MSP fully paid claims.
The FISS maintainer is developing a utility to identify and systematically adjust claims that were incorrectly processed due to the issue identified above. In the interim, providers that feel their claims were processed incorrectly can initiate adjustment claims in lieu of waiting for the FISS utility to automatically create the appropriate adjustments for the affected claims.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers