MSP process for Home Health PPS

Path: Patient > General > Payers

MSP claims can be submitted for an episode after primary claims have been paid for the same dates of service. To enter final claim information into the CMS-sponsored PC-Ace Pro32 software:

1. In the CSP field of the Pay Control grid in Patient > General > Payers, select Medicare PPS Insurance Code.
   1. Note: To assist with reporting and tracking, Netsmart recommends that you define a company called MSP Medicare Secondary Payer to associate with Medicare when an MSP exists.
2. Primary claims are processed based on the payer definition. Payments and adjustments are posted accordingly.
3. Run the MSP Tracking report in the Queries component. For more information, see About MSP Tracking report or Download and run MSP Tracking Report query instructions.
   1. This report must be downloaded from the Netsmart Homecare Client Support website.
4. Run the Patient Services report. For more information, see Patient Services report).
   1. This report lists all services that a patient received during an episode.
      1. These services are keyed into the Pc-Ace Pro32 software.
      2. When you run this report, enter the date range of the patient episode and use the option to select individual patients.
      3. Choose to show full patient and service detail.
5. In Transactions>General>Load Patient Balances, create accounts receivable for MSP PPS claims .
   1. Select the appropriate patient code and pay source for Medicare secondary Payer, and then enter the ageing date (the date you enter the claim in the PC-Ace Pro32 software), the episode from and thru dates, and the expected reimbursement amount for the MSP claim as the beginning balance.