Medicare Secondary Payer

Medicare Advantage Billing Setup Workflow

To set up a payer for processing Medicare Advantage claims, complete the following tasks:

1.	Set Up Medicare Advantage Insurance.

2.	Set Up Reporting of HIPPS Details (FL 42-49). You may also Verify HIPPS Scores for Medicare Advantage.

3.	Set Up Reporting of the Date for HIPPS Details (FL 45).

4.	Set Up Reporting of OASIS Matching Key. You may also review Considerations for Reporting OASIS Matching Key and Authorizations.

Creating Accounts Receivable for MSP Claims (Home Health)

When creating accounts receivable for MSP claims, be aware of the following considerations.

>	You can enter a zero beginning balance. Entering zero gives you the ability to post payments and adjustments as necessary. Using zero prevents the patient from being including in the Accounts Receivable report. For more information, see Accounts Receivable Report.

At the conclusion of posting payments received by Medicare, follow your agency's accounting rules to bring the records to a zero balance.

>	For Home Health PPS, you can enter the total expected episode payment (EEP). This requires that the balance be adjusted to zero once payment is received.

>	You can enter the adjusted reimbursement amount as determined by Medicare (MSP) calculations.

Netsmart recommends that you create an adjustment code specifically for MSP adjustments for easier tracking and reporting.

To ensure MSP claims are ageing for the correct accounting period, Netsmart recommends that you select the following privileges in Administration > Operators > Privileges:

>	Transactions > Load Patient Balances: Full Access

>	Transactions > Load Patient Balances Ageing Date: Ageing dates must be prior to CGSD or after Close AR date.

MSP Process for Home Health PPS

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.

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 MSP Tracking Report or How to Download and Run MSP Tracking Report Query instructions. This report must be downloaded from the Netsmart Homecare Client Support website (www.netsmart.com).

4.

Run the Patient Services report. For more information, see Patient Services Report). This report lists all services that a patient received during an episode. These services are keyed into the Pc-Ace Pro32 software. When you run this report, enter the date range of the patient episode and use the option to select individual patients. Choose to show full patient and service detail.

5.

In Transactions>General>Load Patient Balances, create accounts receivable for MSP PPS claims . 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.

MSP Tracking Report

The MSP Tracking and Patient Services reports provide you with information to enter MSP claims (Home Health) into the PC-Ace Pro32 software. You can download the MSP Tracking report from NetsmartCONNECT .

The MSP Tracking report has two sections:

>	A Patient List of all patients who have Medicare payer defined as a CSP in Patient > General > Payers for the dates specified.

>	The primary claim details for the patients listed in the first section based on payment and adjustment details on the primary claim balance.

How to Download and Run MSP Tracking Report Query

Log in to NetsmartCONNECT.

6.	Click Documentation.

7.	Click Queries.

8.	Click the PPS query report type, then select MSP Tracking report.

9.	Load the query.

10.

To run the report, open the Query component.

11.

In the selection tree, double-click MSP Tracking Report.

12.

In the Search window, enter the from and through dates for the billing period.

13.

Select the appropriate business unit and current patient status by which to filter report, if necessary.

14.

Click OK.

The report appears in the Preview window.

15.

If needed, print or save the report in the necessary format using the Preview toolbar.