What is the quickest way to infuriate patients when completing the MSPQ? “Asking ‘dumb’ questions simply because they’re on the questionnaire,” says Kevin Willis of Claim Services Inc., who offers some examples:

On what date did you retire? A 25-year-old patient, entitled to disability, is standing before the registrar. “If you read without paying attention, you will ask when they retired,” Willis notes. “That patient is going to think you are goofy.”

If one asks a patient for a retirement date, one may find out that the real question is whether he or she retired at all. According to the definition, a patient has not retired if he or she is on long-term disability with his or her former employer. “They are not going to retire from there but are not on the payroll, either,” Willis adds.

Asking “When did you retire?” can flummox even the calmest person. Patients search in vain for this piece of information in their memory banks. Some insist they wrote it someplace, but they cannot remember where? A friendlier version of this question: “Did you work after you got Medicare?” This gets right to the point. “If the answer is ‘no,’ you can go to the next question,” Willis explains. “You’re not asking them the month and year anymore because it’s right on the card.”

Making assumptions causes problems with MSPQ. A patient may have Medicare due to a disability, and has been receiving a Social Security check two years prior to starting Medicare. “Does that mean they can’t have a job? No,” says Willis, noting that one patient had lost her leg but continued teaching. She was on Medicare because of the disability.

“But for the most part, if you are disabled in the eyes of the federal government, you are probably not working — but you are probably not ‘retired,’ either,” Willis adds.

Do you have a job? Going strictly by the MSPQ, registrars might take it even further by asking the same person if anybody in their family has a job. “If you think about it, that could be very insulting,” Willis says. This question’s purpose is to allow the patient to use their parents’ coverage or to use the insurance of a significant other who is not their spouse by allowing another group plan to be primary to Medicare. “It’s not there so that you ask the patient if anybody in their family has a job. But that’s the way it comes off if you read the question to the patient,” Willis explains.

Is a government grant going to cover your service? Blank looks follow this perplexing query. The patient may answer with another question: What does that mean? “The registrar is going to say, ‘I don’t know what it means. I just have to read this question to you,’” Willis notes.

While this exchange may seem comical, patients find it frustrating. “You lose credibility with the patient by asking questions that you yourself don’t understand,” Willis offers.

The obvious problem is that for this particular question, the patient does not know the answer. “The whole purpose is to ask if the hospital got some money. And the hospital — not the patient — is the one that knows that,” Willis adds.

Does your spouse work for a company that employs 20 or more people? “At this point in the registration process, you’ve almost certainly gleaned the patient’s marital status,” Willis says. The MSPQ is worded as if every patient is married on the service date. If the patient is not married, then asking him or her about their spouse’s employment is not relevant. This is the case regardless of whether the spouse is deceased, the patient is divorced, or the patient never married. Asking a patient whose spouse died a decade earlier for the spouse’s retirement date also is unnecessary.

Were you in an accident? Sometimes, there is no need to search for answers where “accidents” are concerned. The information is in plain sight if the patient is there for laceration and fractured femur treatments. The patient may deny there was an accident. To most people, “accident” means a car crash, not falling while getting out of the bathtub or slipping on an icy stoop. Likewise, the registrar might not suspect an “accident” if the primary diagnosis is seizure; yet, the patient needed stitches because of a fall injury that happened during the seizure. In the world of MSPQ, that is an accident.

Do you hold somebody responsible for this accident? One can ask this in multiple ways, some far more confusing than others. “However you formulate the question, the real question is: ‘Did somebody pay you, or are you trying to get money out of somebody?’” Willis says. Asking patients the claim number or the name of the attorney they hired is pointless because that information is going to be available at the time of registration. “It really helps to know how the answer is used. It puts you in a better position to interview the patient,” Willis says.