MEDICARE SECONDARY PAYER (MSP)

MEDICARE SECONDARY PAYER (MSP)

Until 1980, Medicare was the primary payor for all Medicare covered services except for services covered by Workers Compensation or Black Lung benefits or paid for by the Department of Veterans Affairs or Other Government Entities. Since 1980, a series of changes in the Medicare law has shifted costs from the Medicare program to private sources of payment.
Federal regulations require healthcare providers to know when they can bill Medicare as the primary or secondary payer. Failure to properly determine the primary payer is a violation of the provider agreement with Medicare. Medicare considers it a fraudulent and abusive practice when a provider regularly submits claims that are the responsibility of another insurer under the MSP provision
.
Presently, Medicare is the secondary payer for individuals

Ø Who are aged 65 or older and currently working with coverage under an employer-sponsored or employee organization group health plan,
Who are aged 65 or older and are covered by a working spouse’s EGHP or employee organization group health plan,
Ø Who are under age 65, disabled, and are covered by a LGHP due to their own or other family members current employment status,
Ø Who receive services covered under Workers Compensation, Federal Black Lung, Automobile, No-Fault, or Liability insurance plans
Ø Who receive services covered under the Veteran
Administration
Beneficiaries entitled to Medicare solely on the basis of ESRD, during a 30 month coordination period
Ø Working Aged