Medicare Secondary Payer

MSP is the term used to describe the patient’s Medicare benefit when Medicare is not responsible for paying first. The term is sometimes confused with “Medicare supplement” used to describe secondary coverage which fills in the “gap” when Medicare is the primary payer. Be sure your staff understands the difference between MSP coverage and a secondary insurance coverage.

Medicare beneficiaries who retain primary insurance coverage from their (or their spouse’s) employer, or those with commercial health benefits, may enroll in Medicare for secondary coverage.

This FAQ addresses the following:

1. What is Medicare Secondary Payer (MSP)?
2. Who is likely to present with MSP coverage in our office?
3. How do we identify patients with MSP coverage?
4. What is coordination of benefits (COB)?
5. Some payers still accept consultation codes.  Will Medicare accept consultation codes for MSP claims?
6. How do we calculate what MSP will pay on a claim?
7. What information is needed for Medicare to process a claim for MSP payment?

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