Training challenge with MSP said ‘huge’

Avoid expensive pitfalls

Is this patient in a Medicare A bed? Does the patient have Medicare coverage, and if so, what type? Is this patient End Stage Renal Disease (ESRD) or disability entitled? What is the patient’s entitlement date? How many lifetime reserve days does this patient have left? Is the patient in their 30-month coordination period for ESRD entitlement?

These are all questions that registrars might have involving Medicare Secondary Payer (MSP) says Kym Brown, CHAM, patient access manager at Saint Elizabeth Regional Medical Center in Lincoln, NE.

The department’s MSP auditor works closely with Brown to provide training to all registration and preregistration staff on the importance of having a correct MSP at the time of registration.

“The MSP audit is a portion of their audited fields in the registration process,” says Brown. “If the registrar has a problem with accuracy, additional coaching and training are implemented. This assists the registrar in meeting our expectations.”

The auditor provides feedback monthly to registration staff on their accuracy regarding MSP. “Copies of the audited MSP questionnaires are given back to each registrar,” says Brown. “It is a coaching opportunity to help the registrars become experts.”

The MSP auditor has mini-training sessions with staff members to familiarize them with the purpose of the MSP questions and to teach them how to form their registration questions to help the patient. “The MSP auditor has taught the registrars the importance of each question and helped the registrars to help the patient answer questions,” says Brown. “The importance of getting the right information on the claim is a focus.”

Give ongoing training

MSP is “a huge training challenge” for patient access, according to Pete Kraus, CHAM, CPAR, FHAM, a business analyst with patient financial services at Emory University Hospital in Atlanta.

“It is a complicated, convoluted set of questions that can challenge even experts,” he says. “We must coax the information we need to answer it accurately from patients or family who are likely to understand even less about it, if they are able to answer at all.”

Feedback from Medicare audits indicated the need to pay more attention to MSP, as well as the financial impact of claims delays and incorrect reimbursement, says Kraus. There is also extra work required by business office and access staff in after-the-fact research and problem resolution resulting from incorrectly completed MSPs, he says.

Emory’s patient access department has designated MSP experts who provide ongoing training on a monthly basis. “Our questionnaire is completed online during the interview process,” he explains. “It is edited so the answer to one question prompts the interviewer to the next appropriate question.”

However, that system doesn’t mean that the answer to the preceding questions were correct or that the interviewer actually went through the questions with the patient. “Because this is such a complicated topic even for CMS to explain, the standing classes are a way to refresh staff memory and review department past MSP performance as well as provide updates,” says Kraus.

Here is what the trainers do to educate patient access staff on MSP:

• They divide the MSP into three categories: age, disability and ESRD, and they concentrate on one category at each training session.

• Attendance is mandatory, and classes are comprised of 30 minutes training and 15 minutes of completing a question-and-answer test.

• Trainers use real examples of incorrectly completed MSPs.

• Remedial instruction is provided on a one-on-one basis.

“Because of the time and preparation involved, the department is looking at the option of using an online educational service to provide monthly MSP instruction and testing to staff,” adds Kraus.


For more information on training involving Medicare as Secondary Payer, contact:

Kym Brown, CHAM, Patient Access Manager, Saint Elizabeth Regional Medical Center, Lincoln, NE. Phone: (402) 219-7316. Fax: (402) 219-7199. Email:

Pete Kraus, CHAM, CPAR, FHAM, Business Analyst, Patient Financial Services, Emory University Hospital, Atlanta. Phone: (404) 712-4399. Fax: (404) 712-1316. Email: