Is Medicare the Primary or Secondary Payor?

Don’t always assume that because a patient has Medicare coverage, that Medicare is the primary payor! An injury related diagnosis code on a claim may alert Medicare that another carrier is primary. Injury and diagnosis codes may be related to a Worker’s Compensation injury, automobile accident, or another third party liability. In each case, another insurer would likely be primary and Medicare secondary. If you see rejections or receive requests for documentation or the other carrier’s EOBs, submit this information within the 120 day appeal deadline date. One intermediary has identified ICD-9-CM codes listed below as codes that may trigger an audit review within Medicare.

ACTION Steps!

1. Verify benefits accurately identifying the primary and secondary payor.

2. Accurately list the primary and secondary payors in the computer system.

3. Watch your EOBs closely!

4. Respond with appropriate correspondence within appeal timeframe.