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- Additionally, your MAC may have information available on their website or MSP page
- For additional information or details about MSP claims, please refer to your contractor's MSP web page
- Jurisdiction M Part B MAC
- Medicare Secondary Payer Manual
However, they may require the beneficiary to verify certain information before updating the file
The provider may submit the primary payer information to Medicare to recoup the payment. However, the beneficiary is responsible for reporting the accident to the BCRC for the recovery process to take place. If the provider fails to submit the DPP, the BCRC will recover the payment.
For a liability situation, the MSP record is usually posted to CWF after the beneficiary files a claim against the associated liability insurance. In the absence of evidence to the contrary, the date the general liability claim is filed against the liability insurance is no later than the date that the record was posted to CWF. Therefore, for the purposes of determining the promptly period (the 120 days), Medicare contractors consider the date the liability record was created on Medicare's CWF to be the date the general liability claim was filed.
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If the patient has Medicare, you should still submit the claim to us even if there is no balance. No-pay bills should be submitted to Medicare to determine the benefit period, update frequency limitations for services and/or satisfy any unmet deductibles.
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The following questions originated from the above-listed event series. The questions are followed by the appropriate answers and the sources of the information are provided. For additional information or details about MSP claims, please refer to your contractor's MSP web page.
Medicare requires eligibility (including MSP) should be checked for all patients. Ensure to have a standard process in place.
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The provider is responsible to adjust the claim. As you cannot reopen this type of claim, you would need to request an appeal. The provider should submit a primary payer EOB for the MAC to process the duplicate primary payment (DPP). If no EOB is submitted, the MAC will recoup the full primary payment.
For Part A claims not related to the open file, remarks indicating "Not related to XX" will help with the claims processing. If the diagnosis codes match an open WC case, that cannot be bypassed, and the claim will need to be submitted for conditional payment.
The MSP provisions do not create lien rights when those rights do not exist under state law. Where permitted by state law, a provider may file a lien for full charges against a beneficiary's liability settlement. The provider may enforce a permissible lien up to the lesser of the amount of the settlement and charges for the services incorporated in the lien. The provider may not charge interest, lien filing, or administrative fees to the beneficiary or against the lien.
- Parts A and B
- Liability Insurance and MSP
- Automobile Insurance and MSP
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Front office staff should have beneficiaries complete the MSPQ and ask beneficiaries for their current cards at each check-in. The MSPQ is required for Part A.
For outpatient services, it should also be determined when the beneficiary has not met his or her annual Medicare Part B deductible. The bill is submitted to inform Medicare of the charges where the deductible may not yet be met. Although Medicare can make no payment, it can apply the expenses to the beneficiary's deductible. A bill is required for crediting the deductible.
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In addition, if the primary insurance recoups their payment at any time and secondary coverage becomes primary, it is important the claim is not past the timely filing limits. If the primary payer requests repayment after the timely filing limit and Medicare received the claim, you may be able to request a reopening.
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The Provider Outreach and Education A/B Medicare Administrative Contractor Workgroup developed this material. Our joint effort ensures consistent communication and education so that providers and physicians have the information they need to submit claims appropriately and receive proper payment in a timely manner.