Medicare Secondary Payer (MSP) Worksheet - DIGITAL FORM
Updated form effective December 7, 2020 (CMS updated/streamlined from previous versions)
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Providers are required to determine whether Medicare is a primary or secondary payer for every admission of a Medicare beneficiary as well as an outpatient encounter with a Medicare beneficiary prior to submitting a bill to Medicare.
This worksheet identifies the questions that should be asked for every admission, outpatient encounter or start of care with exceptions provided.
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*This this digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment). After 1- year, your update subscription will automatically renew.