Which term would be used to describe Medicare recovery after the primary payer has processed the claim?

Which term would be used to describe Medicare recovery after the primary payer has processed the claim?

• A. Conditional Payment
• B. Secondary Payment
• C. Recovery
• D. Rebate

Answer: (A)

When a payer like Medicare covers a service before the responsibility of another payer is known, that payment is described as conditional. Medicare makes this advance so care isn’t delayed while the primary payer’s liability is being determined, with the understanding that Medicare will be repaid if the primary payer ends up paying. This term fits the scenario of Medicare recovery after the primary payer has processed the claim because the payment is contingent on the primary payer’s action and may be recovered later. It’s not simply a secondary payment, which is a routine payer after the primary; nor is it a generic recovery or a rebate, which don’t capture the conditional advance and the potential for later recovery.

When a payer like Medicare covers a service before the responsibility of another payer is known, that payment is described as conditional. Medicare makes this advance so care isn’t delayed while the primary payer’s liability is being determined, with the understanding that Medicare will be repaid if the primary payer ends up paying. This term fits the scenario of Medicare recovery after the primary payer has processed the claim because the payment is contingent on the primary payer’s action and may be recovered later. It’s not simply a secondary payment, which is a routine payer after the primary; nor is it a generic recovery or a rebate, which don’t capture the conditional advance and the potential for later recovery.