Patient access leaders can use these strategies for Medicare as Secondary Payer (MSP) training
Executive Summary
Incorrectly labeling Medicare as the primary insurance, or missing payers that are primary to Medicare, often costs facilities greater reimbursement and puts hospitals at risk for audits/fines. To avoid problems with the Medicare as a Secondary Payer Questionnaire:
- Don’t sacrifice accuracy for speed.
- Ensure staff members understand the purpose of each question.
- Present questions so that patients fully grasp their meaning.
Elizabeth Reason, MSA, CHAM, director of patient access for Cleveland County HealthCare System in Shelby, NC, has two goals with Medicare as Secondary Payer questionnaire (MSPQ) training.
"Not only do I want the patient access staff to get the right information documented on the MSPQ; I want them to be able to explain it to the patient in layman’s terms," she says. Reason uses these approaches for training:
• She encourages staff to learn about Medicare, Coordination of Benefits, and MSP from the patients’ perspective.
"Learning about Medicare from a patient’s perspective drives home how important it is for us to get the bill right so the organization can receive reimbursement timely," says Reason.
It also helps staff members understand the patient’s perspective. Reason asks her staff to read the following Medicare bulletins, all available on the Medicare.gov website: Medicare and You (http://1.usa.gov/1w7EBXi), Medicare and Other Health Benefits: Your Guide to Who Pays First, (http://1.usa.gov/1s2tITy) and Medicare Coverage of Kidney Dialysis and Kidney Transplant Services (http://1.usa.gov/WyterC).
"It is easy for us to get technical and use revenue cycle terms, but patients deserve a response in terms they can understand," says Reason. "Reading these bulletins helps us translate that message into patient-friendly terms."
• She educates staff continually.
"Annual re-education is important," says Reason. Staff obtain online education and validate competency by taking a quiz. "Regular education during staff meetings is also important," says Reason. "It generates discussion and reinforces concepts through staff experiences."
• She asks staff members to share MSP scenarios, and she uses these case studies at staff meetings.
"End-stage renal disease scenarios can be confusing, so it is important to mix a few of those into the case study approach," Reason says. Calculating the coordination period for beneficiaries eligible for Medicare due to end-stage renal disease who have group health coverage is a significant challenge itself.
Another training scenario involves a patient with group health insurance, who has a transplant, and who has to start dialysis again after 36 or more months. "If group health insurance is involved, the 30-month coordination period starts all over aagain," says Reason.
Training needs to address how liability situations impact Medicare beneficiaries and how to educate patients on the information needed to file the medical claim appropriately. "This is especially difficult when the injury occurred at a family or friend’s house," says Reason. "The Medicare beneficiary has to request the family member or friend file a homeowner’s claim."
VA cases also can be problematic, because the beneficiary needs to choose whether the service is VA-related or Medicare-related. "Unfortunately, personal preference can play a role in VA cases," says Reason. "This further complicates primary payer assignment, which can result in claim payment delays."
All completed MSPQs are audited at Children’s Hospital Medical Center in Cincinnati, Kristy Fazzio, quality control auditor for registration services, looks for missing or incorrect items, such as the patient’s commercial insurance coverage identified as the employer group health plan, or incorrect indication of whether the coverage is through a current or former employer.
In some cases, Fazzio contacts the patient or family for missing information, such as a spouse’s retirement date. "You can complete the MSPQ without entering the data. The registration will let you skip over certain answer fields," she explains. "So staff don’t always realize that it necessitates a response," she says.
The Contract Management & Compliance Office is asked to audit a sampling of the MSPQ audits completed by Registration Services. Patrick Burke, training and quality control auditor for registration services, says, "We ask them to look at what we do, and they verify that we are passing back correct information to staff. Partnering with them has vastly improved the quality of the MSPQs."
For example, the compliance office reported that for some MSPQs, patients went off Medicare at some point after their visit, so the MSPQ information for that date of service audited by the Contract Management & Compliance Office could not be verified as correct. "While registrars in the transplant clinic see MSPQs every day, registrars working in an ENT clinic may only see these once a year," says Burke. These registrars can call a newly implemented registration hotline, staffed by four trainers and quality control auditors.
