NGS CMS Sample Admission Questions to Ask Medicare Beneficiaries 2013-2024 free printable template
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Instructions and Help about medicare secondary payer questionnaire 2021 form
As an employer what do you need to know about how Medicare interacts with your group health plan Liliana Salazar chief compliance officer Western Region of hub International discusses how Medicare secondary payer rules impact the administration of your group health plan and the coordination of benefits now that we've obtained an overview of Medicare let's talk about how Medicare interacts with my group health plan I'm an employer what do I need to know about Medicare and how it interacts with my group health plan so the first item to note is what is your size are you an employer with 20 or more employees in the current or the preceding calendar year based on what we refer to as IRS control group so do you have a sister company or a parent company if the answer is yes, and you have more than 20 employees in aggregate then you will be deemed to be subject to the Medicare secondary payer rules the Medicare secondary payer rules will set the parameters for group health plans in determining the order of payments so who pays first who pays second what else does it do if States employers you may not either penalize coerce or induce an employee to choose to enroll in Medicare over your group health plan, so there are prohibitions and there will be a 5000 penalty per violation if you either provide a financial incentive or you just tell someone who is age 65 I'm very sorry you cannot enroll in your plan you have access to Medicare enroll in Medicare you're not eligible to enroll in our program if you're subject to Medicare secondary payer rules engaging that type of practice could result in the imposition of the 5000 penalty in addition to having those claims reprocessed where your group health plan becomes primary and Medicare would become secondary it also establishes rules for individuals who are they calling them working age meaning individuals aged 65 or older individuals who have disabilities or individuals who are on the retirement health care program or Cobra now if you have less than 20 employees Medicare secondary payer rules will not apply to you and that means that you can at age 65 tell an employee you have the option of enrolling in Medicare you can still and remain in our plan as an example but note that because we have less than 20 employees based on a control group basis Medicare will be primary payer and that means that my insurance carrier assuming and fully insured will take your Medicare eligibility into account in processing any claims meaning that they'll consider that the person has access to Medicare before processing the claim therefore the employee will have a huge out-of-pocket expense because Medicare pays first the group health plan to be secondary and if they're not enrolled in Medicare then that out-of-pocket expense will become the responsibility of that employee note that you should also exercise caution as to any type of claims for age discrimination if you are trying to coerce someone to enroll in Medicare versus...
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