CMS Pub. 100-05, ch. 5, § 60.1.3.1

The MSP Contractor, A/B MAC and DME MAC reports data by total and by source as shown

below:

Total Column

All MSP savings regardless of source

Workers' compensation (WC) column (including black lung (BL)) (codes 15 & 41)

The MSP Contractor, A/B MACs and DME MACs include data related to all MSP savings

resulting from medical benefits provided by the WC Plans of the 50 States, the District of

Columbia, Guam and Puerto Rico. In addition, it includes Federal WC provided under the

Federal Employee's Compensation Act, the U. S. Longshoremen’s and Harbor Workers'

Compensation Act and its extensions, and the Federal Coal Mine Health and Safety Act of 1969

as amended (the Federal BL Program). It keeps separate records for each distinct category (WC

and BL). The MSP contractor identifies recovery savings under Post Pay Recoveries for the

columns identified below.

NOTE: VA savings are now counted under the column titled “VA/Other Federal.”

Working Aged Column (code 12)

The A/B MACs and DME MACs include data related to all MSP savings resulting from benefits

payable under a GHP for beneficiaries aged 65 and older that are covered by reason of their own

employment or the employment of a spouse of any age. Under section 1862(b) of Title XVIII of

the Social Security Act, Medicare is the secondary payer for individuals age 65 or over who are

covered under a GHP by virtue of current employment status of the individual or the individual’s

spouse. The individual, or spouse, who is covered under the GHP must be employed by an

employer that has 20 or more employees. Section 1862(b)(1)(A)(ii) of the Social Security Act

permits small employer GHPs an exclusion from the MSP provisions, if the employer employs

less than 20 employees and the employer makes the exclusion.

End Stage Renal Disease (ESRD) Column (code 13)

The A/B MACs and DME MACs include data related to all MSP savings resulting from

benefits payable under a GHP for individuals who are entitled to Medicare benefits on the basis

of ESRD during a period of up to 30 months. The period during which Medicare pays

secondary benefits is defined in Chapter 2, §20.2.

Auto Medical/No-Fault Column (code 14)

The A/B MACs and DME MACs include data related to all MSP savings resulting from:

Automobile Medical/ No-Fault Insurance – Include data related to all MSP savings

resulting from insurance coverage (including a self-insured plan) that pays for medical

expenses for injuries sustained on the property or premises of the insured, or in the use,

occupancy or operation of an automobile, regardless of who may have been responsible for

causing the accident. This insurance includes, but is not limited to automobile, homeowners,

and commercial plans. It is sometimes called “medical payments coverage,” “personal injury

protection,” or “medical expense coverage.”

NOTE: Auto medical/ no-fault is captured under this column. auto liability is captured under

the Liability column.

Disabled Column (code 43)

The A/B MACs and DME MACs include data related to all MSP savings resulting from

situations where Medicare is the secondary payer for disabled beneficiaries under age 65 (except

ESRD beneficiaries) who elect to be covered by a large group health plan (LGHP) based on their

current employment or a family member's current employment. An LGHP is any health plan that

covers employees of at least one employer who normally employs 100 or more employees.

Liability Column (code 47)

The A/B MACs and DME MACs include data related to all MSP savings resulting from liability

insurance --Insurance (including a self-insured plan) that provides payment based on legal

liability for injury, illness, or damage to property. It includes, but is not limited to, automobile

liability insurance, uninsured motorist insurance, homeowners' liability insurance, malpractice

insurance, product liability insurance, and general casualty insurance. (Note: Where the

beneficiary receives medical payment under his or her own homeowners' insurance, it should be

reported under auto medical/ no fault).

The MSP contractor, A/B MACs and DME MACs shall report the savings for Federal Tort

Claim Act (FTCA) cases in the Liability column. The FTCA shall be reported under code 47.

FTCA cases arise when a person is injured on Federal property, in or by a Federal vehicle, via

medical malpractice at a Veterans Administration (VA) hospital or at any government sponsored

hospital setting and Medicare pays conditionally. In an FTCA case, the other Federal agency has

the responsibility to refund Medicare as any other third party payer refunds Medicare. FTCA

cases are classified as a self-insured entity. These recoveries are liability recoveries. The

responsibility of a recovery for FTCA cases shall be to identify Medicare’s recovery claim

amount and to coordinate/facilitate communications with other the MSP contractor, A/B MACs

and DME MACs, as required by the Centers for Medicare & Medicaid Services (CMS) central

office. For FTCA cases, the MSP contractor shall be the lead contractor for liability and no-fault

cases. These recoveries will continue to be under the specific direction of CMS staff as

necessary.

Veterans Administration (VA)/Other Federal Column (codes 42 & 16)

The A/B MACs and DME MACs include data related to all MSP savings resulting from

situations where the VA pays for fee-for-service medical care received by Medicare

beneficiaries. “Other Federal” means another Federal program is primary to Medicare. The A/B

MACs and DME MACs include data related to all MSP savings resulting from situations where

another Federal program pays for fee-for-service medical care received by Medicare

beneficiaries.

NOTE: Workers’ compensation cases are reported under the column titled “Workers’

Compensation column.”