Jurisdiction M Part B - Medicare Secondary Payer (MSP) (2024)

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Jurisdiction M Part B - Medicare Secondary Payer (MSP) (2024)

FAQs

What is the Medicare Secondary Payer MSP program? ›

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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Is a 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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What is the CMS secondary payer rule? ›

Medicare Secondary Payer (MSP) is the term used by Medicare when Medicare is not responsible for paying first. In other words, any “liability insurance policy or plan,” which includes self-insured plans, must be billed first, prior to any claim presented to Medicare. See Medicare Secondary Payer.

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

For example, if you're admitted to a hospital, your employer-sponsored insurance would pay first, and Medicare Part A may cover costs that exceed what your primary insurance paid. Medicare Part B (medical insurance) may also serve as a secondary payer.

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What does MSP mean with Medicare? ›

Medicare Secondary Payer. Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare.

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How does Medicare Part B pay as a secondary payer? ›

If the amount that the primary payer allows for the service is higher than the Medicare-allowed amount, Medicare will pay the amount up to the higher fee (as long as the amount reimbursed by Medicare does not exceed the Medicare-allowed amount).

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What are three instances when Medicare is considered a secondary payer? ›

Medicare may be the secondary payer when a person: has a GHP through their own or a spouse's employment, and the employer has more than 20 employees. has a disability and is covered by a GHP through an employer with more than 100 employees.

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

Thus, any providers, physicians, and other suppliers that bill Medicare for services rendered to Medicare beneficiaries must determine whether or not Medicare is the primary payer for those services.

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What is Section 111 of the Medicare Secondary Payer Act? ›

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) added mandatory reporting requirements with respect to Medicare beneficiaries who have coverage under group health plan (GHP) arrangements as well as for Medicare beneficiaries who receive settlements, judgments, awards, or other payment ...

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How do I submit a MSP claim 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.

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How often does the MSP questionnaire need to be completed? ›

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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Can you have Medicare Part B and employer insurance at the same time? ›

Can I combine employer health insurance with Medicare? If you or your spouse are working and covered through an employer, you can also decide to keep this coverage and enroll in Original Medicare, Part A and/or Part B to get additional health coverage.

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Is Medicare secondary payer the same as Medigap? ›

The term Medicare supplement (i.e., Medigap) should not be confused with Medicare Secondary Payer. Medicare supplemental is a private health insurance policy designed specifically to fill some of the “gaps” in Medicare's coverage when Medicare is the primary payer.

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Is MSP the same as QMB? ›

Medicare offers several Medicare Savings Programs (MSPs) that assist people with low income and assets: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Individual (QI) and Qualified Disabled Working Individual (QDWI). California also offers the 250% California Working ...

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Does MSPQ need to be completed for Medicare Advantage plans? ›

39A: Yes. 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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When a patient is covered by a primary payer plan and a different secondary payer plan? ›

WITH MORE THAN ONE SOURCE OF INSURANCE COVERAGE

COB also ensures that the primary plan pays as if it were the only plan. The secondary plan and any subsequent plans pay the difference between the billed amount and the payment made by the primary plan.

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