tci General Surgery Coding Alert - 2023 Issue Q4

Reader Questions: Know When Primary Payer is Medicare

Question: We have a patient on Medicare who is also insured through a group health plan from a small business. We know the Medicare Secondary Payer rules, but how do we determine when Medicare is the primary insurance? Nevada Subscriber Answer: Although most practices understand Medicare Secondary Payer (MSP) rules, you’re not alone in your confusion about how to know when Medicare is the primary payer. There are myriad patient circumstances that determine which insurer should be billed first and when that payer is Medicare. Here’s a list of when Medicare is the primary payer: Patient is...

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