Q&A: Figuring out who is the primary insurer

Virginia Martin, CPC, CHBC

The author, president of Healthcare Consulting Associates of N.W. Ohio Inc., has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assi

Medicare is usually the secondary payer, but not always. Check with the patient to see what other type of coverage is involved.

Q: There is much confusion in our billing office regarding when Medicare is primary or secondary. We constantly have rejections because of this issue. Is there an easy way to determine a patient's Medicare status?

A: The answer to knowing when Medicare is primary or secondary lies in talking to the patient to elicit information and knowing a few guidelines. The Centers for Medicare & Medicaid Services provides a great resource called "Welcome to Medicare Secondary Payer," which can be found at http://www.cms.hhs.gov/COBGeneralInformation/. Basically, there are some standard situations in which Medicare is almost always the secondary payer: