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Conditional Payments


Medicare Secondary Payer (MSP) is the term generally used when the Medicare program does not have primary payment responsibility - that is, when another entity has the responsibility for paying before Medicare. When Medicare began in 1966, it was the primary payer for all claims except for those covered by Workers' Compensation, Federal Black Lung benefits, and Veteran’s Administration (VA) benefits.

In 1980, Congress passed legislation that made Medicare the secondary payer to certain primary plans in an effort to shift costs from Medicare to the appropriate private sources of payment. The MSP provisions have protected Medicare Trust Funds by ensuring that Medicare does not pay for items and services that certain health insurance or coverage is primarily responsible for paying. The MSP provisions apply to situations when Medicare is not the beneficiary’s primary health insurance coverage. Medicare statute and regulations require that all entities that bill Medicare for items or services rendered to Medicare beneficiaries must determine whether Medicare is the primary payer for those items or services.

Primary payers are those that have the primary responsibility for paying a claim. Medicare remains the primary payer for beneficiaries who are not covered by other types of health insurance or coverage. Medicare is also the primary payer in certain instances, provided several conditions are met.

Cattle & Gonzalez, PPLC, is Sentinel's Strategic Partner and the only national law firm focusing its entire law practice on Medicare and Medicaid secondary payer issues. They represent auto and workers' compensation insurance companies who are faced with Medicare related cases regarding Conditional Payments, Post-Final Demand Conditional Payment Appeals, MSA Legal Opinions, MSA Allocations, Medical Cost Projections, Section 111 Reporting Data Audits, MSP Claims Closure Projects, and Medicaid Lien Resolution.

Visit Cattle & Gonzalez, PPLC online below and take action to obtain representation from the nation's Number #1 Medicare and Medicaid secondary payer experts. You can call them at (844) 546-3500. 

Click on the images below to navigate to information related to the Medicare Secondary Payer Act and Medicare Set-Aside. The FAQs have been prepared and shared by Cattle & Gonzalez, PPLC.

Conditional Payments


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