Medicare Compliance & Reimbursement
Find Clarity on MSP Types
Question: I鈥檓 trying to navigate situations in which a patient is a Medicare beneficiary but also has other insurance. I know this situation is called Medicare Secondary Payer (MSP). What are the different types of MSPs? Washington Subscriber Answer: You may see the acronym MSP in situations where the Medicare beneficiary has other insurance that is considered the primary carrier, meaning that Medicare is not necessarily responsible for paying for care. This can cause issues when submitting claims, because Medicare Administrative Contractors (MACs) may deny claims billed to Medicare, in acknowledgement that they should have been submitted to a different carrier. Here are the 鈥渢ypes鈥� of MSP that can be submitted on electronic claims, according to MAC : MSP Type Description 12 Working Aged: age 65 or over, employer鈥檚 group plan has at least 20 employees 13 End Stage Renal Disease (ESRD): 30-month initial coordination period in which other insurer is primary 14 No-Fault Situations: Medicare is secondary if illness/injury results from a no-fault liability. This type would most likely not be submitted to Palmetto GBA because we will pay services conditionally, as primary, based on your decision to submit the claim to Medicare for the Liability situation. In these cases, we do not require MSP information. 15 Workers鈥� Compensation (WC) situations 41 Black Lung benefits 43 Disability: under age 65, person or spouse has active employment status and employer鈥檚 group plan has at least 100 employees 47 Liability Situations: Medicare is secondary if illness/injury results from a liability situation Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC
Medicare Compliance & Reimbursement
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Find Clarity on MSP Types
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