Certified Revenue Cycle Representative (CRCR) Practice Exam

Under MSP rules, when can providers bill Medicare for liability claims?

1. After 60 days pass

2. As soon as the claim is filed

3. 120 days pass, but the claim can then be withdrawn from the liability carrier

4. Once the treatment is completed

The correct answer is: 120 days pass, but the claim can then be withdrawn from the liability carrier

The correct answer indicates that providers can bill Medicare for liability claims after 120 days have passed, and at that point, there is also the option to withdraw the claim from the liability carrier. This aligns with the Medicare Secondary Payer (MSP) rules that dictate how billing works when there is another primary payer involved, such as liability insurance. When a liability insurance claim is filed, it is expected that the liability carrier should be responsible for paying the claim initially. However, if the claim is not resolved within the specified period of 120 days, providers can submit their claims to Medicare. The rationale behind this timeframe is to ensure that providers have a reasonable opportunity to receive payment from the primary payer (the liability insurance) before seeking reimbursement from Medicare, which acts as the secondary payer. Moreover, once the provider opts to bill Medicare after the 120-day period and if the liability claim is still unresolved, they may withdraw it from the liability carrier to proceed with the Medicare billing. This understanding is essential for maintaining compliance with MSP regulations and ensuring proper revenue cycle management within healthcare billing practices.