CMS recently reminded providers of their responsibilities under the Medicare Secondary Payer (MSP) Rules. Under the MSP Rules, Medicare is secondary to certain other payers in the following circumstances:
- Workers' compensation (WC) plans, for employment-related injuries or diseases
- No-fault (NF) insurance, if available, for non-employment related injuries, regardless of whether the insurance plan stipulates it is secondary to Medicare
- Third-party liability (L) insurance (e.g., med pay) or self-insurance plans for covered illnesses or injuries
- Employer group health plans (GHPs) of employers with at least 20 employees, for employees who have Medicare by reason of age and are covered under that GHP based on their, or a spouse's, current employment with that employer
- GHPs of employers with at least 100 employees, for employees who have Medicare by reason of disability and are covered under that GHP based on their, or another family member's, current employment with that employer
- GHPs during the 30-month coordination of benefits period, for employees who have end-stage renal disease (ESRD), and are either entitled to Medicare initially based on ESRD; or by reason of age or disability
- Government research programs, for services that are part of the research program
- The Department of Veterans' Affairs, for services they authorize at a non-VA facility
- Under the MSP Rules, the primary responsibility of providers is to determine whether other coverage is available for each visit or admission and, if so, whether Medicare is primary or secondary to that other coverage