Conditional payments are Medicare payments for Medicare covered services for which another insurer is primary payer, made under the condition they are subject to repayment if and when the primary payer makes payment. [IOM Pub 100-05 MSP Manual]
Providers may file a Medicare secondary payer (MSP) claim and request a conditional payment for a Medicare-covered service when another payer is responsible for payment and is not expected to pay promptly (i.e., within 120 days). This article features a reference table that highlights the information that should be included within the MSP claim.
Please review this article for details on how to properly bill Medicare secondary payer (MSP) and conditional payment request claims on 837 institutional claims, and the use of occurrence code (OC) 24 and date of denial.
This article includes a quick reference table that will help the billing staff of providers, physicians, and other suppliers determine whether Medicare is the primary or secondary payer based upon specific situational criteria. The information included within the table is based upon the “Medicare Secondary Payer Fact Sheet” published by the Centers for Medicare & Medicaid Services (CMS).
The purpose of this fact sheet is to provide a general overview of the MSP provisions for individuals involved in the admission and billing procedures for health care providers, physicians, and other suppliers.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.