Billing When Medicare Is a Secondary Payer

Skilled nursing facility (SNF) and other providers who bill for services offered to Medicare beneficiaries should be aware of Medicare billing requirements. Medicare law requires all entities that bill Medicare to decide whether Medicare is the primary payer before submitting a claim to Medicare. When another insurer is found to be the primary payer, providers should bill that insurer first.

Providers should not deny treatment, entry into a SNF, or services based on an open or closed Liability (L), No-Fault (NF), or Workers’ Compensation (WC) Medicare Secondary Payer (MSP) record on the beneficiary’s Medicare file or if a claim was inappropriately denied. You must continue to see or provide services to the beneficiary.

Key Reminders

• Collect full beneficiary health insurance information upon each visit or admission.
• Find the primary payer before submission of a claim, and bill the proper responsible payer(s).
• Check Medicare Eligibility to identify accident or injury diagnosis codes for L, NF, or WC MSP periods.
• For multiple services, bill each responsible payer(s) separately.

To view a Centers for Medicare and Medicaid Services (CMS) fact sheet with further details on billing Medicare as a secondary payer, click here.

Contact: Ken Allison, kallison@leadingageny.org, 518-867-8820