MSP = Medicare Secondary Payer
Applies when Medicare is not the beneficiary’s primary insurance
■More than $4.5 billion saved annually on claims paid by primary insurers
Job-related illness or injury covered under Worker’s Compensation
■Accident injuries covered under no-fault and/or liability insurance
■Federal Black Lung Program
■Veteran’s Benefits program for service-related conditions
■Public Health/Other Government Agency
•All entities that bill Medicare are required to determine whether Medicare is primary for those services
Common MSP Situations
■65 and older covered by Group Health Plan through current employment or spouses current employment
■Disabled and covered by Large Group Health Plan through current employment or family members current employment
■End Stage Renal Disease and Group Health Plan coverage
MSP information
■Required for beneficiaries under FFS
■Required for eachinpatient admission and outpatient encounter
•Recurring outpatient services –verify MSP information at least every 90 days
•Not required for non-patient services (reference labs)
MSP Questionnaire or similar process to identify other primary payers
■Ask questions to verify MSP information in Common Working File (CWF)
■Keep electronic or hardcopy documentation showing development of MSP information for at least 10 years