CMS Medicare Specialist Benefits Coordination & Secondary Payer Rules 2

Question 1

What is the purpose of the Medicare Coordination of Benefits (COB) contractor?

Accepted Answer

To identify other insurance coverage and coordinate payment between Medicare and other payers

Answer

The COB contractor collects and maintains data on Medicare beneficiaries' other insurance coverage to coordinate payments correctly.

Question 2

Under the MSP rules, which of the following is NOT a situation where Medicare pays secondary?

Accepted Answer

A Medicare beneficiary who has no other insurance coverage

Answer

When a Medicare beneficiary has no other insurance, Medicare pays as the primary (and only) payer.

Question 3

What is a Coordination of Benefits Agreement (COBA) in the Medicare system?

Accepted Answer

An agreement between Medicare and other insurers to electronically share claims data for crossover billing

Answer

A COBA is an electronic data-sharing arrangement allowing Medicare to automatically send crossover claims to secondary insurers after Medicare processes them.

Question 4

When a Medicare beneficiary is covered by both Medicare and Medicaid, which program typically pays first?

Accepted Answer

Medicare pays first; Medicaid pays last as the payer of last resort

Answer

Medicaid is always the payer of last resort; Medicare pays primary and Medicaid may cover remaining cost-sharing for dual-eligible beneficiaries.

Question 5

What is the MSP conditional payment process?

Accepted Answer

Medicare pays for services when another insurer should be primary, then seeks reimbursement from that payer once a settlement is reached

Answer

Medicare may make a conditional payment when another payer is primary but has not yet paid; Medicare then recovers that payment once the primary payer settles.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Medicare Specialist Benefits Coordination & Secondary Payer Rules 2