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Some good news about the Health Care Financing Administration (HCFA) revising its policy on Medicare Secondary Payer (MSP) requirements has been circulating. The problem has been that, so far, access managers haven’t been able to find the information in any official missives from the agency. When the on-line news service AHA News Today reported HCFA was relaxing MSP rules, by cutting back on the number of times questionnaires must be completed and how long they have to be kept, Hospital Access Management shared the information with its readers in a brief announcement.
Unfortunately, access managers eager to take advantage of the changes reported to HAM that they couldn’t find confirmation on the HCFA Web site or from communications from their Medicare fiscal intermediaries. That doesn’t surprise Kathy Chadoir, owner of CMBS Consulting in Milwaukee and previously a longtime employee of United Government Services (UGS), the Medicare intermediary for Region 5, which includes Wisconsin.
It’s not unusual, she notes, for HCFA to issue informal communiqués to its Medicare intermediaries that don’t reach providers. Sometimes the communications are verbal and never even make it into print, Chadoir says. In making its news announcement on the MSP changes, she speculates, AHA News — which could not be reached for comment — may have been made aware of an informal communication to intermediaries. Complicating the situation further is the fact that the intermediaries for the various regions operate somewhat independently, interpreting the HCFA regulations in various ways. "It’s all up to your region and how [that intermediary] enforces the guidelines," she adds. "From an auditing standpoint, some are more relaxed than others. UGS went by the book. There was no gray area."
In October 2000, Chadoir notes, HCFA issued a communiqué to intermediaries stating they cannot hold a provider noncompliant for being unable to produce specific MSP questionnaires during an on-site audit. "If the auditors were to request 15 specific questionnaires, and they could produce only 10, the provider can’t be held noncompliant," she adds. Before that HCFA communication, Chadoir says, UGS had required providers to produce all requested questionnaires.
As to whether providers must get MSP questionnaires completed at every encounter when there is a series of patient visits — an ongoing question for many access managers — she says she has been aware since at least 1997 that this is not necessary. At that time, while she was still working for UGS, Chadoir says, she checked with HCFA on the issue and was told that providers "don’t have to do it every time as long as they update periodically." However, she notes, HCFA "won’t say what periodically’ is, and has never clarified the requirement in print. "[HCFA] will never say, Don’t do them,’" Chadoir adds. "They just won’t be that definitive."
In the case of recurring patient visits — as with chemotherapy treatments, for example — most providers update the MSP information at 30-day intervals, she says. "They say, We saw you 30 days ago. Has anything changed since then?’"
When auditing those accounts, Chadoir explains, UGS checks to make sure that the UB92 bill type matches what the questionnaire states. "The first bill in the series should be 132,’ every bill after that should be 133,’ and the final discharge bill should be 134,’" she says. "If you just bill at the beginning and end of the series, then it’s 132’ and 134.’ That was never put out in a bulletin to providers, only to intermediaries, and even to them, it wasn’t in black and white."
The last piece of information she heard regarding the recurring visit policy, she notes, was that HCFA was revisiting the requirement, possibly in the wake of a threatened lawsuit by an advocacy group or a beneficiary that considers the repeated questioning an invasion of patients’ rights.
Chadoir says she expects an official transmittal from HCFA regarding the MSP requirements by the middle of the year. She speculates the agency may be changing "the whole section of the manual" that deals with the subject.
[Editor’s note: Kathy Chadoir may be reached at 7916 W. Mill Road, Milwaukee, WI 53218. Phone: (414) 649-7070.]