MSP Recovery

30.5 – MSP Recovery (Rev. 11755, Issued:12-21-22, Effective: 01-23-23, Implementation: 01-23-23) The MSP Manual outlines Medicare’s right to recover payments it has made on behalf of private insurers that are the primary (or “first”) payers for Medicare beneficiaries. This information is currently found in Chapter 7 of the Medicare Secondary Payer Manual. In situations where Medicare is a “secondary” payer, the primary payer must reimburse Medicare for any benefits that Medicare has mistakenly paid as primary on behalf of a beneficiary. The MSP program ensures that Medicare is aware of situations where it should not be the primary (the first) payer of claims. If a beneficiary has Medicare and other health insurance, Medicare COB) rules decide which entity pays first. Medicare may make conditional payments on behalf of beneficiaries so that beneficiaries can maintain continual Medicare coverage throughout the COB period. Any such payments are conditioned on reimbursement to the appropriate Medicare trust fund.