Revamp MSPQ processes: Over half of hospital revenue is possibly at risk
Training cut MSPQ 25% in three months
If the Medicare as Secondary Payer Questionnaire (MSPQ) is not complete, your patient access department faces denied claims, lost revenue, and potential loss of Medicare funds.
"If we are not compliant with completing the MSPQ, Novant Health is at risk of losing approximately 55% of its revenue," says Tate Batson, assistant director of onsite access for Novant Health’s Charlotte and coastal markets in North Carolina.
By implementing a fail-safe MSPQ process, you are likely to see fewer RTPs (Returned to Providers), says Batson. "This results in fewer accounts receivable days, and less rework in the business office," she says. Here is Novant Health’s MSPQ process:
• Batson works with the hospital’s Information Technology Services team to identify MSPQs that were not answered completely.
These claims are now held until they’re corrected, which avoids costly denials. "Holds are identified with reports or work queues," Batson says. "Discrepancies are resolved before the claims are released."
• Patient access leaders implemented a quality assurance tool that allows registrars to link the MSPQ and the Common Working File response.
"This ensures that we are complaint with CMS [Centers for Medicare & Medicaid Services] regulations and reduces denials," says Batson.
• The department’s MSPQ process is integrated into registration pathways, so that the questionnaire is asked at each visit.
"If a discrepancy does exist, we resolve it by contacting the Coordination of Benefits office," says Batson.
Patient access leaders at Central DuPage Hospital, Winfield, IL decreased MSPQ errors by 25% in a three-month period. "A critical step is how we circle back to the user’s errors," says Barbara Novak, revenue cycle manager.
Errors are grouped by the type of error, the department, and the user. This information is shared openly with employees.
"No one likes being on the top of this list," says Novak. "Access leaders then ask for more information. What did the front-end user initially enter? What corrections did billing make?"
Audits reveal inconsistencies
At UK HealthCare in Lexington, KY, patient access leaders have been through several audits of the department’s MSPQ process and billing compliance, conducted by internal and external auditors.
"Establishing the proper reason for eligibility was one area that was highlighted," says Courtney M. Higdon, MBA, director of Enterprise Patient Access Services. Although no payments were made in error, there were inconsistent answers with the Coordination of Benefits assigned to accounts.
"The audits helped us to further develop two specific strategies within patient access, to support best practice and optimal performance in this area," says Higdon. These two changes were made in the past year:
• Patient access leaders developed a more robust auditing program for the completion and accuracy of the MSPQ.
"We established automated methods through real-time system reports, to validate the completion of an MSPQ for every patient that is a Medicare beneficiary," says Higdon.
Previously, staff identified problems through batch review and rectified them later in the revenue cycle. This made errors more difficult and costly to correct.
Staff now catch the problems in real-time so they can be corrected right away, before claims are sent out. "This reduces the amount of staff rework that previously took place later in the revenue cycle," says Higdon.
For example, if staff members discover that the MSPQ was not completed at all for a Medicare beneficiary, this can be corrected while the patient is still in the hospital or clinic. "Currently, we are creating mechanisms to do some editing of the MSPQ answers, in order to reduce conflicting answers and missing information," says Higdon.
• Patient access leaders worked hard to train all patient access staff about MSPQ.
"The problem with this issue is that it is complex. It can sometimes be confusing, for staff and for patients," says Higdon. "The retirement date is always an area that is easy for staff to be confused about, as well as the guidance around ESRD [End-Stage Renal Disease] eligibility."
Managers developed online training on this topic, and they added training on MSPQ to initial classroom training for new hires and annual refresher training. However, they soon realized that constant focus on MSPQ is necessary.
"We have strengthened performance expectations of our staff in this area as part of our patient access job promotion process," Higdon reports.
Staff members are reminded that billing correctly the first time minimizes delays in payments, which creates a positive impact on cash flow. "Additionally, maintaining compliance with federal guidelines on this issue minimizes our risk of having payments recouped," says Higdon. (See related story, below, on training on MSPQ processes.)
For more information on Medicare as Secondary Payer Questionnaire processes, contact:
• Tate Batson, Assistant Director, Onsite Patient Access, Charlotte and Coastal Markets, Novant Health, Winston-Salem, NC. Phone: (704) 384-4069. Fax: (704) 316-9667. Email: email@example.com.
• Courtney M. Higdon, Director, Enterprise Patient Access Services, UK HealthCare, Lexington, KY. Phone: (859) 257-6780. Email: Courtney.Higdon@uky.edu.
• Barbara Novak, Revenue Cycle Manager, Central DuPage Hospital, Winfield, IL. Phone: (630) 933-6514. E-mail: Barbara.Novak@CadenceHealth.org.
• Nikki Taylor, CPAR, Assistant Director, Patient Access Services/Patient Accounts, Georgia Regents Health System, Augusta. Phone: (706) 721-8001. Fax: (706) 721-1818. Email: firstname.lastname@example.org.
MSPQ is `tricky’ despite education
Ongoing, one-on-one training needed
Despite the large amount of revenue at stake, completion of the Medicare as Secondary Payer Questionnaire (MSPQ) remains a tough educational challenge, according to patient access leaders interviewed by Hospital Access Management.
"The MSPQ is so important to complete accurately, but at times it can be tricky," acknowledges Nikki Taylor, CPAR, assistant director of patient access services and patient accounts at Georgia Regents Health System in Augusta.
Incorrect completion of MSPQ is one of the most common root causes of inaccurate registrations reviewed by Taylor.
A recent month’s report identified this problem in two accounts for day surgery patients. These were used as training tools for patient access staff. "Using these accounts to follow up with employees and provide training is very helpful," says Taylor.
Peers provide training
Registrars at Novant Health in Winston-Salem, NC, are educated on MSPQ by attending classroom training during orientation, completing interactive online modules, and during staff meetings.
"It’s important to provide ongoing training to reiterate the importance of completing the MSPQ," says Tate Batson, assistant director of onsite access.
Patient access leaders at Winfield, IL-based Central DuPage were disappointed with the results they were getting from electronic and group training to address MSPQ problems, so they came up with a different approach.
"We have added another type of communication: the one-on-one staff update," says Barbara Novak, revenue cycle manager. These sessions are informal, take 10 or 15 minutes per staff member, and involve a review of the error and what should have been entered.
About 10% of the patient access employees are designated as "super users" who assist with the one-on-one MSPQ training.
"Staff appreciates this training from a peer. It is the only way we have been able to keep up with this," says Novak. "Otherwise, the resource and time issue becomes an obstacle."