Outpatient Facility Coding Alert - 2018 Issue 8
Determine Medicare or Private Payer with This Handy Chart
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Article Overview
This article summarizes a practical Medicare secondary payer overview from a CGS Medicare webinar. It is aimed at coders, billers, and reimbursement staff who need a quick reference for common coordination-of-benefits situations involving Medicare, employer plans, Medicaid, Tricare, workers’ compensation, and accident-related coverage. The guidance is organized as a chart-style comparison of situations where Medicare is typically primary versus when it is usually secondary.
Why This Topic Matters
Correct payer order is essential for submitting claims to the right insurer first and reducing denials, delays, and coordination errors. This topic is especially relevant for practices that commonly see patients with multiple insurance sources or Medicare eligibility interactions.
What You Will Learn
- Common situations that affect Medicare primary versus secondary status.
- How coordination of benefits may change based on age, disability, employment status, and family coverage.
- How special coverage types such as ESRD, COBRA, Medicaid, Tricare, workers’ compensation, and liability or no-fault insurance fit into payer-order review.
- Why dual-eligibility and other overlapping coverage situations require careful payer determination.
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Insurance verification staff
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