Billing for Services When Medicare is a Secondary Payer

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

On February 23, 2021, CMS posted MLN Matters: SE21002 … Billing for Services When Medicare is a Secondary Payer.

This MLN Matters® Special Edition (SE) Article is for physicians, hospitals, Skilled Nursing Facilities (SNFs), suppliers and other providers who bill Medicare Administrative Contractors (MACs) or Durable Medical Equipment (DME) MACs for services provided to Medicare beneficiaries.

Medicare law and regulations require all entities that bill Medicare for services or items given to Medicare beneficiaries to decide whether Medicare is the primary payer for those services or items before submitting a claim to Medicare. (See Section 1862(b)(2) of the Social Security Act and regulations at 42 CFR 489.20g.)

This 3-page special edition contains information on these items:

  • Provider action needed
  • What to do if you believe Medicare inappropriately denied a claim
  • Key reminders
  • Resources and references

Be sure to share this SE with your billers.

[If you are not using the updated MSP worksheet – implemented December 7, 2020, check out these options: #3535P … Medicare Secondary Payer (MSP) Worksheet or #3535E … Medicare Secondary Payer (MSP) Worksheet – DIGITAL FORM.]