Medicare as Secondary Payer
Exercise 14.1 – Medicare as Secondary Payer
Review the following cases and determine the CMS – prescribed billing order for each.
Example: Patient is retired and covered by Medicare, an employer-sponsored retirement plan, and his spouse’s employer-sponsored large group plan.
Billing Order: Employer-sponsored large group plan, Medicare, employer-sponsored retirement plan
The patient is the policyholder in an employer-sponsored large group and has Medicare, a Medigap policy, and a $100-per-day extra coverage hospital plan.
Billing Order:____________________________________________________________________________
2.The patient has Medicare and an employer-sponsored retirement plan, and the patient is a dependent on the spouse’s employer-sponsored large group plan. The claim is for an injury received in a car accident.
Billing Order:_______________________________________________________________________________
3.The patient has a retirement plan through his former employer, Medicare, and a cancer policy. The patient is diagnosed with cancer. The spouse is deceased.
Billing Order:_____________________________________________________________________________
4.The patient is 67, working full-time, and covered by Medicare, an employer-sponsored large group plan, and a Medigap plan. The spouse is retired, 62, and covered by an employer-sponsored plan for 18 employees.
Billing Order:_________________________________________________________________________________
5.The patient is 50 and disabled and has Medicare and an employer-sponsored group health plan that covers 50 employees.
Billing Order:___________________________________________________________________________________
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