Here’s one response from an intermediary

No MSP form required’

The Hospital and Health System Association of Pennsylvania in Harrisburg issued memos to its members dated April 2, 1999, and Sept. 3, 1999, that included several questions posed to Veritus Medical Services, the Medicare Part A intermediary for most providers in Pennsylvania.

Here are those questions, with responses from Veritus:

Can a hospital either change, modify, or eliminate any of the questions listed on the MSP form?

A hospital cannot change, modify, or eliminate any of the questions on the MSP form. Hospitals may add questions, but they should be listed at the end of the "mandated" questions.

Is an MSP form required when a hospital performs an outpatient diagnostic test using a specimen obtained from a Medicare patient not physically present?

If a hospital performs an outpatient test on a specimen received from a beneficiary not physically present, no MSP form is required. Hospitals must, however, have procedures in place to attempt to identify other insurance coverage by checking the common worker file, the intermediary files, or the hospital’s own files for previously received insurance information.

Does an MSP form have to be completed if the patient is not present at the hospital?

No. If the hospital does a test on a specimen received from a doctor’s office, an MSP form is not needed.

What if the specimen is obtained by hospital personnel at a nursing home or during a home health visit?

Because the patient was not at the hospital, no MSP form must be completed. Hospitals still should check their internal computer files for possible insurance information they may have obtained from a previous visit.