The Centers for Medicare and Medicaid Services (CMS) emphasize that providers must investigate all options to find out whether Medicare is the secondary payer in each individual case. The MSP questionnaire lists the type of questions you must ask of Medicare beneficiaries for every admission, outpatient encounter, or start of care.
A Medicare beneficiary may have additional health insurance coverage through another plan or program. When the beneficiary receives services, a decision must be made about which coverage has primary responsibility for payment and which one is the secondary payer. A primary payer is the insurance company or program that pays benefits first. A secondary payer is the insurance company or program that pays a portion or all of the remaining charges not covered by the primary payer. The Federal Government has rules for deciding when Medicare pays your health care bills for Medicare-covered services and when other types of insurance must pay first.
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Medicare Secondary Payer (MSP) is the term used when Medicare is not responsible for paying health care claims first. Since 1980, Congress has passed laws making Medicare the secondary payer in a number of situations. These situations are listed here.
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