Mar 11 2025 1:00PM

Medicare as Secondary Payer Billing in the SNF

To meet the requirements of their Medicare provider agreement, all Medicare providers, including Skilled Nursing Facilities (SNFs), must identify payers that are primary to Medicare, bill such primary payers before billing Medicare and submit MSP claims when required or conditional claims when appropriate.

In this session, SNFs will learn how to prepare and submit MSP and conditional claims for Medicare. MSP claims are claims submitted to Medicare after the primary payer has paid in part or in full. Conditional claims are claims submitted to Medicare after the primary payer made a decision not to pay but for a valid reason (example: their payment was applied toward the plan’s deductible) or are claims submitted to Medicare after the primary payer has not paid the provider within 120 days (accidents only).

Highlights from this session include:
• A review of MSP and conditional billing codes
• A review of the Fiscal Intermediary Shared System Direct Data Entry (FISS DDE) pages used for claim submission
• SNF billing examples for a variety of MSP situations

Knowing how to code MSP and conditional claims properly will expedite claims processing and any potential Medicare payment to your SNF!