What Is Medicare Secondary Payer Mandatory Reporting?

Medicare is a governmental insurance program for the elderly and disabled. Those who are 65 or older, or who have permanent, lifelong handicaps, are eligible to apply. Medicare Secondary Payer Mandatory Reporting refers to the duty of certain entities to report to Medicare when the insured's medical benefits are paid by other means.

Why

• Medicare requires that mandated agencies report when cardholders receive benefits from other sources in order to decrease what is known as double billing. Double billing occurs when beneficiaries or their healthcare providers bill both Medicare and other sources for the same treatments.

Where

• Although the insurance provided by Medicare covers many health care necessities for beneficiaries, other sources of payment are available and must sometimes be used before Medicare can be billed. These include worker compensation benefits and compensation from civil lawsuits resulting in bodily injury.

Who

• Not everyone needs to report to Medicare if a secondary payer is involved. The only entities that are required to do so are called Responsible Reporting Entities. However, penalties do exist for individuals who bill Medicare for services that should have been covered by a secondary payer.