What is a conditional payment in Medicare?

A conditional payment in Medicare refers to a scenario where Medicare makes a payment for services on the condition that the primary insurance has not yet made a payment or the provider has not yet billed the primary payer. This typically occurs when a beneficiary has dual coverage, meaning they have both Medicare and another insurance plan.

In these situations, Medicare allows for a payment to be made to ensure that the healthcare provider is compensated for the service while waiting for the primary insurance to process the claim. However, the payment made by Medicare is considered "conditional" because it will be recouped once the primary payer has processed their claim and made a payment. This mechanism prevents the beneficiary from being held responsible for the costs of necessary services while ensuring that Medicare only pays when it is truly responsible for payment.

The other options do not accurately describe the nature of a conditional payment; for instance, unconditional payments or payments for non-covered services are outside the scope of this definition.