Скачать или смотреть Part 5 Medicare Primacy Exceptions

Part 5 – Verification, Evidence & Case Closure
COB Master Class | Medicare Secondary Payer (MSP)

Determining Medicare primacy isn’t complete until the evidence is verified, documented, and defensible.

In Part 5 of the COB Master Class, Allen Horn walks through the full investigator workflow for Medicare verification—covering IVR access, representative calls, entitlement confirmation, documentation standards, and final case closure.

This module shows how auditors move from theory to proof.

🔍 In This Video, You’ll Learn:
📞 Medicare Verification Workflow

Navigating Medicare IVR correctly and efficiently

When IVR data is sufficient—and when it is not

Escalating to a live Medicare representative

Recording rep name, ID, and call outcome

🧠 Decoding Entitlement Evidence

How to identify entitlement reason:

Age

Disability

ESRD

Why the entitlement reason dictates the MSP rule

Confirming Part A and Part B effective dates

Understanding First Date of Dialysis (FDOD) for ESRD

⚖️ Complex Scenarios: Dual Entitlement

How Medicare resolves multiple entitlement reasons

The Hierarchy of Truth:

Age overrides Disability

ESRD follows special coordination rules

Why confirming the correct entitlement reason is critical to primacy

🔑 The Golden Key: MBI

Why the Medicare Beneficiary Identifier (MBI) is essential

When and how to request it

Why cases should never be closed without it

🗂️ Documentation & Tracker Standards

Proper Medicare call notation:

Representative name

Entitlement reason

Effective dates

Correct use of status codes

Creating notes that tell the story of the investigation

✅ Final Verification: Case Closed

Confirming overlaps and primacy

Verifying dates and status updates

Ensuring the case is ready for recovery

These procedures align with guidance from Medicare and the Centers for Medicare & Medicaid Services and are designed to withstand audit review.

👨‍🏫 Meet Your Instructor

Allen Horn is a professional Coordination of Benefits (COB) auditor specializing in Medicare Secondary Payer compliance, audit documentation, and recovery-ready workflows. This Master Class reflects real investigation standards used in production audit environments.

📘 About the Series

This is Part 5 of a 10-part COB Master Class designed to take auditors from rule interpretation to recoverable results.

👉 Subscribe and turn on notifications to continue the series, including:

Advanced recovery scenarios

High-risk MSP overlaps

Audit defensibility strategies

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