tci Medicare Compliance & Reimbursement - 2023 Issue Q3

Reader Questions: Figure Out When Medicare Is the Primary Payer

Question: One of our patients has Medicare but is also insured through a group help plan from a small business. We know the Medicare Secondary Payer rules, but how do we determine when Medicare is the primary insurance? Texas Subscriber Answer: Many practices are schooled in the MSP regulations, but there is confusion about when Medicare is the primary payer. There are myriad patient circumstances that determine which insurer should be billed first and when that payer is Medicare. Here’s a list of when Medicare is the primary payer: Patient is age 65 or older and covered by...

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