When Medicare will act as secondary payer
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Question / Problem
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When Medicare will act as secondary payer?
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Solution
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Medicare Secondary Payer is the term used by Medicare when another payer pays primary to Medicare.
Medicare is secondary payer to
- beneficiaries covered for health care benefits through their Group Health Plan (GHP)
- or a spouse’s or family member’s GHP, disability, End Stage Renal Disease (ESRD),
- and for automobile, no-fault liability, Workers’ Compensation (WC),
- Veterans Affairs (VA)
- and Black Lung (BL) situations.
Prior to billing Medicare, providers must ensure they are billing the correct primary payer. When another payer is responsible for payment and the payment has not been made or cannot be expected to be made promptly, Medicare may make a conditional payment for Medicare-covered services.
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Applies to |
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Medical Billing
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