Regardless of whether or not the provider expects payment from Medicare, the provider is required to submit the claim to Medicare.
Medicare Secondary Payer (MSP) is the term used to describe a situation in which another insurer may make payment for services rendered primary to Medicare. It is the provider’s responsibility to identify the beneficiary’s primary payer by conducting a screening process at admission, and viewing online MSP files in CWF. The provider must bill the primary payer first and Medicare second when services rendered would be covered by another payer to Medicare. Providers should follow the MSP screening process described in Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-05, Medicare Secondary Payer Manual, Chapter 3, Section 20.
|
|
Regardless of whether or not the provider expects payment from Medicare, the provider is required to submit the claim to Medicare. |
When submitting claims involving an MSP situation, specific data is required to be reported on the claim.
The home health rap claim (TOB 3x2) is still required (for 5+ visits) and should be submitted in the usual manner when submitting MSP. Only the home health final claim (TOB 3x9) will contain MSP necessary information.