EXECUTIVE SUMMARY

Incomplete or inaccurate completion of the Medicare Secondary Payer questionnaire causes significant problems for the revenue cycle. The following strategies can help prevent those problems:

  • Offer guidance instead of merely reading questions verbatim.
  • Tell patients why information is needed.
  • Interpret patients’ responses instead of simply recording what they say.

“Did you have an accident?” “What was your date of retirement?” “Are you within your coordination period?”

With questions like these, it’s no wonder that proper completion of the Medicare Secondary Payer questionnaire (MSPQ) causes major headaches for patient access.

“Read the questionnaire and imagine a reasonably educated 65-year-old trying to make heads or tails of any of it,” says Kevin Willis, director of Medicare services at Claim Services, a claims adjusting company based in Aurora, IL. Willis, a former Medicare Secondary Payer auditor, frequently lectures on this topic.

Often, registrars have no idea why any of the MSPQ information is necessary. “The common belief is that these questions are just a way the Medicare program makes us all jump through hoops,” says Willis.

Not a Dictation Tool

Patients hate being asked the same annoying questions every time they come in. “What percentage of any patient population knows exactly what qualifies as a group health coverage?” asks Willis. “How many understand how and when a federal grant covers the services they are about to receive?”

The inevitable incorrect responses cause many problems for patient access. “The document itself is treated by many patient access staff as a dictation tool — ‘I’ll read this, the patient will say something, I’ll capture it, and we’ll move on,’” says Willis.

Registrars simply record what the patient says, without offering guidance or interpreting what the patient really means. “The MSPQ is designed to guide the registrar through the process of interviewing the patient,” explains Willis. “It’s akin to a game of chess.”

The end result is always a little bit different, based on the individual patient’s particular situation. “It’s not just reading something to somebody,” says Willis.

If asked, “What is your date of retirement?” patients get frustrated because they can’t come up with the exact date. The patient also doesn’t know the reason for the question. To get the correct response, the registrar can instead simply ask, “Did you work after you received Medicare?”

“Patients can understand that question’s value,” says Willis. The registrar can further explain, “Well, Medicare just wants to know the last time you worked. And if you retired before you got your Medicare, we’ll just use the Medicare date.”

Registrars who read the MSPQ verbatim may find themselves asking a 25-year-old who is entitled to Medicare due to a disability when he or she retired. “If instead, you ask that same patient if they worked after getting Medicare, you appear a lot less dimwitted,” says Willis.

Only Partially Complete

MSPQ completion is the focus of many training sessions at Thomas Jefferson University Hospitals in Philadelphia. “It has presented its challenges, for sure,” says Barbara Rubino, CRCE-I, director of patient access.

Sometimes, the troublesome task needs to be done without a patient physically present. “When we don’t see patients face-to-face, getting the form completed can be a challenge. We then need to follow up,” says Rubino. The MSPQ is a requirement for all Medicare patients and registrations, recurring every 90 days. “Luckily, our form is electronic within our registration pathway. It automatically fires appropriately during registration,” says Rubino.

New employees are trained on how to complete the form. Monthly reports are run for quality assurance. “We now can run a report on ‘complete,’ ‘partial,’ and ‘not at all,’” says Rubino.

The most common problem is that registrars fail to complete the MSPQ in its entirety. “Our training sessions include the requirements from Medicare, how to complete the form, why it is needed, age, disability, end-stage renal disease, practice sessions, and a final assessment,” says Rubino.

Incorrect Information

Confusing questions and annoyed patients aren’t the only problems registrars face with MSPQ completion. They’re also dealing with faulty data. “Patient access is bombarded with incorrect information — from patients and even from payers,” says Willis.

If a patient presents with face lacerations and a fractured femur that occurred from a fall injury at a friend’s home, he or she will probably answer “no” if asked, “Did you have an accident?”

“But that’s the wrong answer,” says Willis. Patients assume the registrar means a car accident, without realizing injuries that occurred in someone’s home are covered by homeowner’s insurance. “If the patient cut their finger at someone’s house, nine times out of 10, that’s not identified at registration,” says Willis. “But if it is, we’ve identified a payer that pays dollar for dollar, instead of the contractual reimbursement, and pays quickly.”

Every registrar knows patients want to be asked as few questions as possible. “If they say ‘yes’ to the accident question, now you have to ask more questions,” says Willis. Failing to probe further often leads to the incorrect payer being selected. No scripting can cover all situations. “I believe scripting is a house built on sand in this arena — not that I haven’t tried,” says Willis.

Nothing replaces a registrar understanding a question, he emphasizes: “In the case of accidents, no registrar can properly administer the question without first understanding no-fault insurance, liability insurance, and how each can be introduced as a result of an accident.”

Don’t Play Blame Game

Getting an accurate MSPQ is a team sport: It’s a joint effort between the front end and the back end.

“There is a rivalry, in almost every hospital system, between registration and financial services — what I call the blame game,” says Willis.

Billing usually faults patient access for completing the form incorrectly. “But there is tons of information that can’t possibly be gleaned at the time of registration,” says Willis.

There’s no way around it — the missing information has to be corrected or added later. “There has to be a burden on the person who is actually formatting the claim to polish it,” says Willis.

For instance, an injured patient coming to the ED after a motor vehicle accident probably won’t even know the name of the other driver, let alone the name of the attorney who will handle the eventual claim. The information is just not available at that point in time.

“While there is a system in place for follow-up with auto accidents, there are other types of liability cases — slips and falls, for instance — that aren’t quite as simple,” notes Willis.

Patient financial services often takes the stance that it’s “registration’s job.” The problem with that is that an incorrect or incomplete form causes problems for the entire revenue cycle, says Willis. At a minimum, identifying the wrong insurance increases A/R days.

“The best case scenario is you bill the wrong insurance primary, they tell you no, and now you have to go to the right insurance,” says Willis. “You’ve just cost yourself a couple of weeks in receivables.”

An even worse scenario: a lost chance for any payment at all. This often occurs if Medicare pays as the primary insurance when they aren’t supposed to, or a commercial payer does so. The claim is paid — but the payer corrects the mistake months down the road.

“It is commonplace for a payer to pay as primary, only to retract its payment — oftentimes over a year later, and say, ‘Wrong payer! You should have billed Medicare — sorry!’” says Willis.

By that time, it’s too late to recoup payment from the correct payer. The lesson learned, says Willis: “When we identify the right payer at the time of registration, everybody benefits.”

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