The Centers for Medicare & Medicaid Services (CMS) seeks to collect various data from the applicable Responsible Reporting Entities (RREs) for purposes of implementing the Mandatory Medicare Secondary Payer reporting requirements of Section 111 of the MMSEA. This information will be used to ensure that Medicare makes payment in the proper order and/or takes necessary recovery actions.
Under the MSP rules Medicare does not have primary responsibility for paying the medical expenses of a Medicare beneficiary. According to the law, Medicare is a secondary payer to Group Health Plans (GHPs) for certain beneficiaries.
A beneficiary for whom Medicare pays second and Group Health Plans (GHPs) pays first is:
1) A Medicare Beneficiary who is aged 65 or older and working with coverage under an employer -sponsored GHP, as a result of being employed by an employer with 20 or more employees (or if it is a multi-employer plan where at least one employer has 20 or more full or part-time employees) OR
2) A Medicare Beneficiary who is aged 65 or older and with coverage under a working spouse's employer-sponsored GHP, for an employer with 20 or more employees (the working spouse can be any age)(or if it is a multi-employer plan where at least one employer has 20 or more full or part-time employees) OR
3) A Medicare Beneficiary who has End Stage Renal Disease (ESRD) and are covered by a GHP on any basis. In this case Medicare pays secondary for a 30 months coordination period OR
4) A Medicare Beneficiary who is disabled and has coverage under his own or a family member's GHP for an employer with 100 or more full or part-time (or if it is a multi-employer where at least one employer has 100 or more full or part-time employees.) Based on the above rules the onus is now on employers to provide mandatory reporting of MSP data.
Recommended Links:
1) Medicare Secondary Payer -MSP Reporting
2) Group Health Plan (GHP)
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