How does Medicare Secondary (MSP) processes the claim and will there be any patient responsibility?
A. Once Medicare Secondary processes the claim then they will send an explanation of benefits that shows how they determined their payment or denial. This is based on the MSP formula that is mandated by CMS in which it is determined by using the total billed charges, the primary payment, the Medicare re-imbursement, and the co-insurance and deductible. Once these four factors are known then a calculation can be done in order to project the Medicare secondary payment. Depending on the primary carrier’s co-insurance and deductible and Medicare’s co-insurance and deductible the patient could have a responsibility. To find the formula used by Trailblazer please visit the Trailblazer website and click on the MSP overpayment calculators or go to the CMS Medicare Secondary Payer Manual to find out more information.
Related Questions
- What happens when the insurance company sends the payment for a claim to the patient rather than the provider? Can we bill the patient the entire amount?
- If TRICARE is the patients secondary insurance, does TRICARE pay the patient liability after their primary insurance processes the claim?
- At what point does the mortgagees responsibility for a Partial Claim end?
