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