Q&A: Figuring out who is the primary insurer

November 21, 2008
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: