Certified Revenue Cycle Representative (CRCR) Practice Exam

What MSP situation requires a Large Group Health Plan (LGHP)?

1. New patients seeking services

2. Disability

3. Routine check-ups

4. Emergency admissions

The correct answer is: Disability

A Large Group Health Plan (LGHP) comes into play primarily when dealing with individuals who qualify for Medicare due to a disability. In this situation, if the individual is under 65 and is entitled to Medicare benefits as a result of a disability, the LGHP acts as the primary payer before Medicare kicks in. This is tied to the coordination of benefits under the Medicare Secondary Payer (MSP) rules, which dictate how payments are processed between Medicare and other insurances based on an individual's eligibility and the type of insurance coverage they have. The other scenarios listed do not inherently trigger an LGHP requirement under MSP rules. For instance, new patients seeking services (especially those not on Medicare) would not automatically involve an LGHP unless they have qualifying group coverage. Routine check-ups are generally considered preventive care and do not specifically require LGHP involvement. Emergency admissions might involve immediate medical attention without regard to other insurance types initially, thus not specifically invoking the need for an LGHP related to MSP considerations.