Certified Revenue Cycle Representative (CRCR) Practice Exam

What do MSP rules allow providers to do regarding billing Medicare for liability claims?

1. File claims immediately

2. Bill Medicare after 120 days passes, but the claim can then be withdrawn from the liability carrier

3. Only bill after the claim is settled

4. Not bill Medicare under any circumstances

The correct answer is: Bill Medicare after 120 days passes, but the claim can then be withdrawn from the liability carrier

The correct answer is that providers are allowed to bill Medicare after 120 days have passed, but they must then withdraw the claim from the liability carrier. This aligns with the Medicare Secondary Payer (MSP) rules, which state that when there is a potential liability for payment, Medicare does not pay until certain conditions are met. In scenarios involving liability claims, if a provider has not received payment from the liability insurer within a specified timeframe, they may submit their claim to Medicare after waiting for 120 days. This is particularly advantageous for providers needing to ensure timely payment for services rendered. If Medicare does process the claim and pays, the provider is then responsible for coordinating with the liability insurer to avoid any duplicate payments. This process helps in managing billing and ensures that Medicare's role as a secondary payer is upheld while also giving providers some assurance of payment. The other options do not accurately reflect the provisions laid out by MSP rules, emphasizing the unique structure of billing for ongoing liability claims.