Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare.  See 42 U.S.C. 1395y(b) [section 1862(b) of the Social Security Act], and 42 C.F.R. Part 411, for the applicable statutory and regulatory provisions.

Information for Health Care Providers regarding MSP Situations

Workers’ Compensation (WC) is a primary payer to the Medicare program for Medicare beneficiaries’ work-related illnesses or injuries. If a Medicare beneficiary has WC coverage, health care providers must bill WC first.

If responsibility for the WC claim is in dispute and WC will not pay promptly, the provider, physician, or other supplier may bill Medicare as primary payer. If the item or service is reimbursable under Medicare rules, Medicare may pay conditionally, subject to later recovery if there is a subsequent settlement, judgment, award, or other payment.

The Centers for Medicare & Medicaid Services (CMS) recommends the following for Part A institutional providers (i.e., hospitals):

CMS recommends the following for Part B providers (i.e., physicians and suppliers):

Access the CMS Medicare Secondary Payer Recovery Portal.