Simple-sounding question is actually complex — Reading questions aloud is `poor approach’
Although it is possible to keep training on Medicare as Secondary Payer (MSP) fairly simple, "there are times when you need to stop, think, and ask a lot of questions," says Elizabeth Reason, MSA, CHAM, director of patient access for Cleveland County HealthCare System in Shelby, NC.
For example, the question "Are you actively employed by an employer of 20 or more employees?" seems very straightforward. Often, it is, but the following hypothetical scenarios can complicate things, says Kevin Willis, director of Medicare Services in the Harrison, OH, office of Claim Services, a document retrieval company. Willis is a former Medicare Secondary Payer auditor.
4 focus areas
Willis developed a two-hour training session devoted solely to these scenarios:
• The patient is on long-term disability and has not retired, or is on short-term disability and has not retired.
"The solution to understanding the actively employed aspect is to understand the federal definition of actively employed,’" says Willis. An actively employed person remains on an employer’s payroll, he explains, and their income is subject to Federal Insurance Contributions Act (FICA) tax.
"Short-term disability surrounds remaining on the payroll. Long-term disability is akin to an insurance payout," says Willis. "One is employed, one is not, and the patient can’t be relied upon to know the difference."
• The patient retired after 30 years on the job but is now working part time as a greeter at a major superstore store chain.
"A greeter at the local department store is on a payroll, and most likely that payroll contains 20 employees or more," says Willis. "They are actively employed, despite having an actual retirement date."
• The patient is under 65 and works for an employer of 30. However, that employer is party to a multi-group plan, and within that plan resides at least one employer of 100 or more.
"Number of employees" within a multi-group plan is measured by the employer within the plan that has the greatest number of employees. "Perhaps a better way of saying it is that if one employer within the plan meets the number criteria, then all meet it," says Willis.
For example, if a two-person team of a physician and his wife run the entire practice, there are only two employees. However, because they are part of a multi-group plan that has one practice well over 100, the two-person team meets the criteria for an employer of 100 or more.
• The patient hasn’t been to work in 20 years but owns his or her own company.
"They held themselves a retirement party 20 years ago but remain on the payroll to glean profits," says Willis. If the company owners leave themselves on the payroll, then they remain actively employed. "Folks get caught up in the semantics game with words like retired,’ working,’ or employed.’ These words mean different things in different contexts," he explains.
Know the reasoning
The above question isn’t unique, says Willis. Every question on the Medicare Questionnaire poses its own points of confusion within the registration process.
"This rabbit’ hole may seem deep, but it is not as deep as some other questions, particularly the accident-related questions," Willis notes.
Members of the patient access staff are more likely to give a correct response if they understand the reasoning behind a particular question. "The questionnaire advises what information is required to bill the Medicare program. It cannot be read aloud to patients to achieve high levels of success," says Willis. For example, the questionnaire will literally ask a 25-year-old on disability, "When did you retire?"
"In some cases, simply reading questions to patients is not just a poor approach to fact-finding," says Willis. "It is also bad customer service."
