CMS Releases Updated Medicare Secondary Payer Publications

The Medicare Learning Network (MLN) updated its simply and easy-to-read publications regarding Medicare Secondary Payer.


The publications address Medicare Secondary Payer obligation from both the group health and non-group health perspective, referencing conditional payment obligations, when Medicare has made a payment and is owed reimbursement from a primary payer.


For non-group health plans, CMS specifically states that in the event of a work-related accident, the workers compensation plan pays first. The publication affirmatively states Medicare pays second where an accident or incident involving no fault or liability insurance is involved. Medicare does not make a payment for liability claims until ongoing responsibility for medical (ORM) funds are exhausted, a reference to Medicare’s non-group health MMSEA section 111 reporting process. A clear indication of Medicare’s intent to recover in liability circumstances, as more specific guidance is anticipated related to Liability Medicare Set Asides (LMSAs) and No-Fault Medicare Set Asides (NFMSAs) in the near future.


Hospitals, providers, and suppliers are urged to gather accurate Medicare Secondary Payer data to determine when Medicare is primary. CMS references its online manuals and tutorials for additional information. The updated Medicare Secondary Payer MLN Booklet is available in two formats at:


https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MSP_Fact_Sheet.pdf


https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/MSP-Fact-SheetTextOnly.pdf



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For more information:

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