Billing in Medicare Secondary Payer (MSP) Liability Insurance Situations

This article is based on information received from Medicare beneficiaries, their legal counsel and other entities that assist these individuals, indicating that providers, physicians, and other suppliers that elect to seek payment from the beneficiary’s liability insurance claim instead of submitting the claim for items or services to Medicare have not generally billed in accordance with the instructions provided or referenced in this article. The FAQs in this article are intended to remind providers, physicians, and other suppliers of the fundamental guidance governing billing where liability insurance (including self-insurance) is involved. Liability insurance (including self-insurance), no-fault insurance, and workers’ compensation benefits are primary payers to Medicare. However, CMS’ regulations and policy for liability insurance billing are distinct from those for no-fault insurance and workers’ compensation benefits. Because the liability insurance billing rules are different and place distinct obligations on providers, physicians, and other suppliers (including termination of liens tied to the expiration of Medicare’s timely filing requirements), it is important that these rules be reviewed in detail.

Source: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE17018.pdf