Practice Management Alert

Question: Is there an easy way to tell if Medicare is the primary or secondary carrier for a patient with multiple carrier coverage?

Oregon Subscriber

Answer: CMS has published an extremely helpful online fact sheet to educate billers on when Medicare is the primary payer. According to the fact sheet, "Medicare remains the primary payer for beneficiaries who are not covered by other types of insurance. Medicare is also the primary payer in other instances, provided several conditions are met."
 
The fact sheet lists numerous common patient coverage situations and indicates who the primary payer is for each. For example, if a patient is age 65 or older - or is disabled - and the patient has both Medicare and COBRA coverage, Medicare is the primary payer.
 
Questions are key: The best way to determine if Medicare is primary is to ask all Medicare beneficiaries about any additional coverage they may have - and you should ask at every visit because insurance information can change quickly, the CMS fact sheet states. Be sure to ask a Medicare patient about any Group Health Plan coverage, Federal Black Lung Program benefits, Workers' Comp benefits, and auto insurance. And ask if the patient is seeking treatment "for an injury or illness for which another party could be held liable," CMS instructs.
 
Great resource: To learn from the many coverage scenarios listed on this Medicare fact sheet, visit www.cms.hhs.gov/medlearn/msp_4a.pdf.