Medicare Financial Management Manual (Pub. 100-06), Ch. 6 § 80.7
Source of Savings - The intermediary reports data by total and by source as shown
80.7 - Source of Savings - The intermediary reports data by total and by source as shown
below:
(Rev. 6, 08-30-02)
A3-3899.7
Column (i)
Total--All MSP savings regardless of source.
Column (ii)
Workers' Compensation, Black Lung, and VA - It includes data
related to all MSP savings resulting from medical benefits provided by
the WC Plans of the 50 States, the District of Columbia, Guam and
Puerto Rico. It also includes Federal WC provided under the Federal
Employee's Compensation Act, the U. S. Longshoremens' and
Harborworkers' Compensation Act and its extensions, the Federal Coal
Mine Health and Safety Act of 1969 as amended (the Federal BL
Program), and any fee-for-service medical care paid for by the VA. It
keeps separate records for each distinct category (WC, BL or VA) as
this may become a reporting requirement in the future.
Column (iii)
Working Aged - It includes data related to all MSP savings resulting
from benefits payable under an EGHP for beneficiaries aged 65 and
older who are covered by reason of their own employment or the
employment of a spouse of any age. Section 3491 further defines the
working aged provisions.
Column (iv)
ESRD - It includes data related to all MSP savings resulting from
benefits payable under an EGHP for individuals who are entitled to
Medicare benefits solely on the basis of ESRD during a period of up to
12 months. The period during which Medicare pays secondary benefits
is defined in the Medicare Claims Processing Manual, Chapter 29,
Coordination with Medigap insurers.
Column (v)
Auto Medical, No Fault and Liability Insurance - It includes data
related to all MSP savings resulting from:
• Automobile Medical or No Fault Insurance - Insurance
coverage (including a self-insured plan) that pays for all, or part, of the
medical expenses for injuries sustained in the use of, or occupancy of,
an automobile, regardless of who may have been responsible for the
accident. (This insurance is sometimes called "personal injury
protection," "medical payments coverage" or "medical expense
coverage.")
• Liability Insurance - Insurance (including a self-insured plan)
that provides payment based on legal liability for injury, illness or
damage to property. It includes, but is not limited to, automobile
liability insurance, uninsured motorist insurance, homeowners' liability
insurance, malpractice insurance, product liability insurance, and
general casualty insurance. It does not include situations where a
beneficiary receives medical payment under his or her own
homeowners' insurance.
Column (vi)
Disabled - It includes data related to all MSP savings resulting from
situations where Medicare is the secondary payer for disabled
beneficiaries under age 65 (except ESRD beneficiaries) who elect to be
covered by a large group health plan (LGHP) as a current employee or
family member of such employee. A LGHP is any health plan that
covers employees of at least one employer who normally employs 100
or more employees. The disabled provisions apply to items and services
furnished on or after January l, 1987 and before January l, 1992