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

Last amended: 2002Year: 2002Length: 494 wordsOfficial source
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
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 | Justis AI