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July 5, 2013 - Revised: 11.27.13

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
  • 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.

Update: the FISS maintainer has developed a utility to identify and systematically adjust claims that were incorrectly processed due to the issue identified above. This utility is expected to go into production on or around December 6, 2013, and claims that were processed incorrectly will be identified and adjusted to process and pay correctly.

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