How Does Medicare Calculate Secondary Payment?

Grouper

Expert
21
Florida
I'm trying to help a client, but am struggling to get the correct answers to questions that are pretty basic. I've been all through the CMS and CMS COB sites but dont find my answer and google searches have not helped.
I sent the following email to my state's blue plan (they also administer Medicare), but they could not/ did not provide a useful answer:

"Joe's spouse has Medicare due to disability (fibromyalgia) as her secondary payor.
She is presently in a SNF and will soon need home health care.
I need to help Joe understand how the Medicare secondary benefit will work.
His BCBS group Plan is primary (20+ employees), but he has a 60 day Per Benefit Period limit on SNF, 35 visits PBP for therapy and 20 visits PBP for home health care.

We need to understand how the Medicare secondary benefit will work.
Please explain:

1- how the Medicare secondary benefit is calculated

2- what are the Medicare visit limits for SNF, PT and HHC?
If the BCBSFL group plan visit limits are exhausted, are the Medicare limits
provided in addition to the group plan or only to the extent that the Medicare benefit is greater than the group visit limits that were already used?"
 
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