CMS Medicare Specialist Benefits Coordination & Secondary Payer Rules

Question 1

Which federal law governs Medicare Secondary Payer (MSP) rules and requires certain insurers to pay primary to Medicare?

Accepted Answer

The Medicare Secondary Payer Act of 1980

Answer

The Social Security Act of 1935

Answer

The Affordable Care Act of 2010

Answer

ERISA of 1974

Question 2

Under MSP rules, which entity is required to pay primary when a Medicare beneficiary is actively employed and covered by an employer group health plan (EGHP) with 20 or more employees?

Accepted Answer

The employer group health plan

Answer

Medicare Part A

Answer

Medicare Part B

Answer

Medicaid

Question 3

What is the MSP coordination of benefits rule for a Medicare beneficiary injured in an automobile accident where auto insurance is available?

Accepted Answer

Auto insurance pays primary; Medicare may pay secondary for remaining costs

Answer

Medicare pays primary; auto insurance pays secondary

Answer

Both pay simultaneously with no coordination

Answer

Only Medicare pays; auto insurance is irrelevant

Question 4

Under workers' compensation MSP rules, when a Medicare beneficiary has a work-related injury, which payer is primary?

Accepted Answer

Workers' compensation

Answer

Medicare Part A

Answer

Medicare Part B

Answer

The beneficiary's supplemental insurer

Question 5

What is a Medicare Set-Aside (MSA) arrangement used for in workers' compensation settlements?

Accepted Answer

To protect Medicare's interests by setting aside funds for future Medicare-covered medical expenses related to the injury

Answer

To pay Medicare premiums on behalf of the beneficiary

Answer

To reimburse Medicare for past payments made on the claim

Answer

To fund Part D prescription drug costs only

Question 6

When a Medicare beneficiary has End-Stage Renal Disease (ESRD) and is covered by an employer group health plan, how long must the EGHP pay primary before Medicare becomes primary?

Accepted Answer

30 months

Answer

12 months

Answer

6 months

Answer

24 months