QUESTION: Do the Medicare Secondary Payor rules apply to our freestanding ambulatory surgery center?
ANSWER: Yes, they do. All Medicare-participating providers are required to file claims with Medicare using billing information obtained from the beneficiary to whom the item or service is furnished and all entities seeking payment for any item or service furnished under Part B are to complete, on the basis of information obtained from the individual to whom the item or service is furnished, the portion of the claim form relating to the availability of other health insurance. Thus, any providers (including ASCs) that bill Medicare for services rendered to Medicare beneficiaries (other than Medicare Advantage Plan members) must determine whether or not Medicare is the primary payor for those services. This must be accomplished by asking Medicare beneficiaries, or their representatives, questions concerning the beneficiary’s MSP status. If the provider fails to file correct and accurate claims with Medicare, and a mistaken payment situation is later found to exist, Medicare can recover its conditional or mistaken payments. All providers are required to retain the information about secondary payors for 10 years. The only difference between hospitals and other providers like ASCs is that hospitals are subject to regular audits by the MAC whereas other providers are not.