Medicare Compliance & Reimbursement - 2018 Issue 5
Part B Payment: Know These MSP Facts to Ensure Medicare Reimbursement
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Article Overview
This article reviews Medicare secondary payer basics for Part B billing and reimbursement. It helps providers and billing staff understand the general circumstances that affect whether Medicare pays first or second, including age-based situations, employment-related group coverage, disability, end-stage renal disease, COBRA, workers’ compensation, liability or no-fault coverage, Medicaid, Medigap, and TRICARE. The content is useful for those who need a high-level reference to coordinate benefits and avoid claim submission errors.
Why This Topic Matters
Correct primary-versus-secondary payer identification is essential for Medicare reimbursement and for coordinating benefits with other coverage. Understanding these common MSP situations can help reduce denials, avoid payment delays, and support more accurate claim processing.
Article Sections
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Medicare Is Primary
This section outlines common situations in which Medicare typically pays before other coverage. It focuses on broad eligibility and coverage categories relevant to primary payer determination.
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Medicare Is Secondary
This section outlines common situations in which Medicare typically pays after another insurer or payer. It addresses broad coordination-of-benefits scenarios used to identify secondary payer status.
What You Will Learn
- How Medicare secondary payer status is generally determined in common Part B situations
- Which broad patient and coverage circumstances can make Medicare primary
- Which broad patient and coverage circumstances can make Medicare secondary
- How employment status, age, disability, and other insurance types affect coordination of benefits
- Why correct payer order matters for Medicare reimbursement workflows
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle specialists
- Medicare providers
- Practice managers
- Compliance staff
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