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 Medicare Secondary Payer Act of 1980 established rules requiring other insurers to pay primary before Medicare in specific circumstances.

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

When a Medicare beneficiary is actively employed and the employer has 20+ employees, the EGHP must pay primary and Medicare pays secondary.

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

Auto insurance is a no-fault or liability insurer that must pay primary before Medicare for accident-related medical costs.

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

Workers' compensation is always primary to Medicare for work-related injuries and illnesses.

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

A Medicare Set-Aside protects Medicare's interests by earmarking settlement funds to cover future injury-related medical costs before Medicare pays.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Medicare Specialist Benefits Coordination & Secondary Payer Rules