Jurisdiction J Part B - Medicare Secondary Payer (MSP) Frequently Asked Questions (2024)

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Jurisdiction J Part B - Medicare Secondary Payer (MSP) Frequently Asked Questions (2024)

FAQs

Is Medicare Secondary Payer Questionnaire required? ›

Medicare regulations require providers who submit Medicare claims to determine whether Medicare is the primary payer or secondary payer for items or services furnished to a beneficiary.

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How often do you have to ask the MSP questions? ›

Both the initial collection of MSP information and any subsequent verification of this information must be obtained from the beneficiary or his/her representative. Following the initial collection, the MSP information should be verified once every 90 days.

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How do you bill Medicare when it is a secondary payer? ›

When Medicare is the secondary payer, submit the claim first to the primary insurer. The primary insurer must process the claim in accordance with the coverage provisions of its contract.

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What are some scenarios where Medicare can be a secondary payer? ›

If the primary payer does not pay claims within roughly 120 days, the healthcare professional may send a bill to the secondary insurer. If this is Medicare, Medicare may make a conditional payment, which Medicare then recovers from the primary insurer.

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Is the MSP questionnaire required? ›

When submitting a claim to Medicare, ask the questions to determine the correct primary payer. Billing for Part A inpatient or outpatient hospital services requires the MSPQ to be completed for every date of service, unless it is for recurring outpatient services.

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What is the MSP law for Medicare secondary payer? ›

The MSP provisions have protected Medicare Trust Funds by ensuring that Medicare does not pay for items and services that certain health insurance or coverage is primarily responsible for paying. The MSP provisions apply to situations when Medicare is not the beneficiary's primary health insurance coverage.

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What is the primary purpose of the Medicare Secondary Payer MSP questionnaire? ›

Providers may use this as a guide to help identify other payers that may be primary to Medicare. This questionnaire is a model of the type of questions that may be asked to help identify Medicare Secondary Payer (MSP) situations.

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What is the Medicare secondary payer questionnaire? ›

This tool is designed to help you determine if Medicare is the primary or secondary payer by walking you through a few simple questions. In certain situations Medicare will pay claims for eligible beneficiaries as a secondary payer to the beneficiary's primary plan.

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How often is the Medicare Secondary Payer questionnaire completed? ›

However, we also encourage home health and hospice providers to review the questionnaire at least every 90 days. Payer sources can change at any time; therefore, it is important that providers stay informed of the beneficiary's status in the Medicare program.

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How do you submit secondary claims to Medicare? ›

Complete the claim form CMS-1500 or electronic equivalent in the usual manner. Report all claim coding usually required for the services including charges for all Medicare-covered services, not just the balance remaining after the primary payer's payment. Report the covered and noncovered charges as usual.

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How do you bill a secondary claim? ›

After the primary insurance processes the claim, note the allowable amount, the patient responsibility and any adjustments. Submit the claim to the secondary insurance. Make sure to include the original claim amount, how much the primary insurance paid and reasons why they didn't pay the entire claim.

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Who is responsible for determining whether Medicare is the primary or secondary payer? ›

Medicare regulations require providers who submit Medicare claims to determine whether Medicare is the primary payer or secondary payer for items or services furnished to a beneficiary.

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What is the purpose of Medicare Secondary Payer? ›

Medicare Secondary Payer (MSP) provisions protect Medicare from paying when another entity should pay first. Any entity providing items and services to Medicare patients must determine if Medicare is the primary payer.

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Does Medicare automatically send claims to secondary insurance? ›

Some claims are forwarded to the secondary and some not. Even if there is a note “Claim Information Forwarded To: (name of secondary)” for each claim, it may not be the case, therefore the secondary claim must be submitted. Speak to your local Medicare carrier and ask how to setup crossovers.

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Can you bill an AWV if Medicare is the secondary payer? ›

Q - Can I bill for a Medicare AWV and a commercial insurance preventive visit for the same patient in the same year? A - Yes, you can do this if the patient has both as part of their covered benefits. Some patients have a commercial payer as their primary insurance and Medicare as their secondary.

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What is the purpose of the Medicare Secondary Payer questionnaire? ›

Providers may use this as a guide to help identify other payers that may be primary to Medicare. This questionnaire is a model of the type of questions that may be asked to help identify Medicare Secondary Payer (MSP) situations.

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When must the mspq be completed? ›

A sample of the MSPQ can be found in the Centers for Medicare & Medicaid Services' (CMS) Internet-Only Manual (IOM), Publication 100-05, Medicare Secondary Payer Manual, Chapter 3, Section 20.2. 1 (PDF). Hospitals are required to verify the information at least every 90 days.

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What is a Medicare secondary payer record confirmation letter? ›

You are receiving this letter because we were notified that you filed a liability insurance (including self-insurance), no-fault insurance, or workers' compensation claim. This is confirmation that a Medicare Secondary Payer (MSP) recovery case has been established in our system.

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