Exercise 14.1 - Medicare as Secondary Payer

Review the following cases and determine the CMS- prescribed billing order for each.

EXAMPLE: Patient is retired and covered by Medicare, an employer-sponsored retirement plan, and his spouse's employer-sponsored large group plan.

Billing Order: Employer- sponsored large group plan, Medicare, employer-sponsored retirement plan.

1. The patient is the policyholder in an employer-sponsored large group plan and has Medicare, a Medigap policy, and a $100-per-day extra coverage hospital plan.

Billing Order:

2. The patient has Medicare and an employer-sponsored retirement plan, and the patient is a dependent on the spouse's employer-sponsored large group plan. The claim is for an injury received in a car accident.

Billing Order:

3. The patient has a retirement plan through his former employer, Medicare, and a cancer policy. The patient is diagnosed with cancer. The spouse is deceased.

Billing Order:

4. The patient is 67, working full-time, and covered by Medicare, an employer-sponsored large group plan, and a Medigap plan. The spouse is retired, 62, and covered by an employer-sponsored plan for 18 employees.

Billing Order:

5. The patient is 50 and disabled and has Medicare and an employer-sponsored group health plan that covers 50 employees.

Billing Order: