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Do 'complete re-education' on Medicare requirements
Joan S. Braveman, director of patient access and financial services at Tallahassee (FL) Memorial HealthCare, says that her department is in the process of doing "complete re-education" on the Medicare Secondary Payer questionnaire.
"Our insurance verification team will do a random review of the responses that are stored online in our ADT system," she reports. "They will be looking specifically at retirement dates, accident information, and spouse information." The random review will be used to give feedback and identify educational opportunities.
Braveman says that "the cause for the re-education is Medicare's Secondary Payer recovery contractors, rather than problems with the questionnaire itself." The questionnaire is built into the department's patient processing and accounting system. When a Medicare patient is registered, it automatically takes the registrar to the questionnaire and pre-populates some of the fields.
"With Medicare now making a much more concerted effort to ensure they are truly primary and actually doing recoveries on old accounts where they were secondary, I felt it important that my comfort level be high in regard to the colleagues' understanding and compliance, with compliance being the key," says Braveman.
Braveman says there are three scenarios that present big challenges:
Receiving a patient who is non-responsive. "Obviously, we cannot ask the patient the questions, but we do look at previous responses on previous questionnaires, as well as the eligibility response, which would show if there is another payer, employment information, and retirement information," says Braveman.
When patient access staff do not see the patient. "We have a large reference lab that processes specimens for which we bill," says Braveman. "Since they do not see the patient, only the specimen, we have to ensure that someone has reviewed all of the information available."
When a patient was in an auto accident in the past and now is receiving services for something unrelated. "Unless we catch these on the front end, we will receive a denial," says Braveman. "We have set up a process whereby the insurance verifier contacts the Medicare billing team so they can bill appropriately. We also ask the patient to contact Medicare to get the file updated."
The education will be provided by the department educator as well as department managers. "Being a 24/7 operation, we have to do some creative scheduling," says Braveman. "We are also looking at educating our patient financial services colleagues. Although they do not interview patients and complete the questionnaire, they do have responsibility for ensuring coordination of benefits."