Medicare Secondary Payer Quiz Key

Is Medicare primary or secondary under the following circumstances?

Disabled beneficiary under age 65: / Primary / Secondary
1.  Is not covered under a LGHP and does not have a spouse / X
2.  Is covered under a LGHP from a current employer; the employer has under 100 employees and the beneficiary has no spouse / X
3.  Is covered under a LGHP from a current employer; the employer has over 100 employees and the beneficiary has no spouse / X
4.  Is not covered under a LGHP from a current employer but the beneficiary has a spouse or family member who is employed and has the beneficiary covered under his/her LGHP and the spouse’s or family member’s employer has under 100 employees / X
5.  Is not covered under a LGHP from a current employer but the beneficiary has a spouse or family member who is employed and has the beneficiary covered under his/her LGHP and the spouse’s or family member’s employer has over 100 employees / X
6.  Is a disabled child and is covered under a parent’s insurance via employer. The employer has under 100 employees. / X
7.  Is a disabled child and is covered under a parent’s insurance via employer. The employer has over 100 employees. / X
Working aged beneficiary age 65 or older and: / Primary / Secondary
1. Is not employed and does not have a spouse / X
2. Is still employed and covered under a EGHP and the employer has under 20 employees / X
3. Is still employed and covered under a EGHP and the employer has over 20 employees / X
4. Is not employed but has a spouse who is employed and has the beneficiary covered under his/her EGHP and the spouse’s employer has under 20 employees / X
5. Is not employed but has a spouse who is employed and has the beneficiary covered under his/her EGHP and the spouse’s employer has over 20 employees / X
End Stage Renal Beneficiary and: / Primary / Secondary
1. Has coverage under a current or former employer and is entitled to Medicare solely on the basis of ESRD and is within the 30 month coordination period / X
2. Does not have any EGHP coverage through self or family member / X
Auto accidents, third party liability, worker’s compensation and black lung and: / Primary / Secondary
1. Beneficiary is involved in an auto, third party liability or worker’s compensation accident. The provider is billing a claim with a diagnosis that is related to the injury / X
2. Beneficiary is involved in an auto, third party liability or worker’s compensation accident. The provider is billing a claim with a diagnosis that is not related to the injury / X
3. Beneficiary is receiving black lung benefits. The provider is billing a claim with a diagnosis that is payable under the Black Lung Program / X
4. Beneficiary is receiving black lung benefits. The provider is billing a claim with a diagnosis that is not payable under the Black Lung Program / X

5.55 points each

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