Question: I’m 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 “types” of MSP that can be submitted on electronic claims, according to MAC Palmetto GBA:
|
MSP Type |
Description |
|
12 |
Working Aged: age 65 or over, employer’s 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’ Compensation (WC) situations |
|
41 |
Black Lung benefits |
|
43 |
Disability: under age 65, person or spouse has active employment status and employer’s 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
