CMS Pub. 100-05, ch. 5, § 70.1.2

Procedures

(Rev. 11550; Issued: 08-12-22; Effective: 10-13-22; Implementation:10-13-22)

A. Entrance Interview

The A/B MAC (Part A) shall conduct an entrance interview with the admissions staff

(including

inpatient, outpatient, and emergency) to determine whether the hospital established:

1. Policies identifying other payers primary to Medicare; and

2. A system in which such policies are carried out in practice.

A/B MACs (Part A) shall use the checklist found in §70.5.3, Exhibit 3 to conduct the

entrance interview. During the interview, the A/B MACs (Part A) shall request a

descriptive walk-through of the admissions process. It is not necessary to observe an

actual admission of a beneficiary.

B. Review of Hospital Admission Questions and Responses

The A/B MAC (Part A) shall review copies of the hospital's inpatient, outpatient, and

emergency room (ER) hospital admission questions and/ or the X12 270/271 transaction

and existing responses and notations. If the hospital uses an online admission query

process, the A/B MAC (Part A) shall review the system screen prints. If the hospital has

both hard copy questions and online questions and responses, the reviewer may exercise

discretion in deciding whether to review hard copy questions or online responses (or

both, if desired). The reviewer shall compare the hospital's admissions questions to the

model admission questions found in the Medicare Secondary Payer Manual, Chapter 3, §

20.2.1) to ensure that the appropriate questions are being asked to identify other payers

that may be primary to Medicare.

Analysis of the admission questions and responses, including the X12 270/271

transaction and existing notations or system screen prints utilized from the provider

online screening process, for purposes of insuring that it matches the information

billed should be undertaken during the review of billing procedures. (See §70.3.B for

instructions.)