The Medicare Secondary Payer (MSP) questionnaire is used as a guideline for long-term post-acute care (LTPAC) providers when speaking with residents to determine whether or not Medicare has primary payment responsibilities—i.e., whether another entity bears responsibility for paying before Medicare.

Richter Healthcare Consultants is pleased to offer an MSP questionnaire with questions to ask Medicare beneficiaries upon each inpatient and outpatient admission. As an LTPAC provider, you may use this as a guide to help identify other payers that may be primary to Medicare.

If you choose to use this questionnaire, please note that it was developed to be used in sequence. Instructions are listed after the questions to facilitate transition between questions. The instructions will direct the patient to the next appropriate question to determine MSP situations.

Fill out the form on this page to download your free questionnaire.