MSP mistakes can cost millions in revenue -- Staff must understand meaning of questions
Most errors involving Medicare as a Secondary Payer Questionnaire (MSPQ) can be attributed to two things, according to 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.
These two items are emphasizing speed over accuracy and "taking dictation rather than conducting a patient interview," says Willis.
Accuracy often is sacrificed to expedite the registration process, with patient satisfaction in mind. "For the average patient, the longer it takes to conduct the intake interview, the less they enjoy their registration experience," notes Willis.
Potential mistakes with MSPQ range from simply missing a retirement date to missing patient and spouse employment and group health plan coverage that is primary to Medicare, says Elizabeth Reason, MSA, CHAM, director of patient access for Cleveland County HealthCare System in Shelby, NC.
"Liability situations may be complex," says Reason. "These usually require additional documentation, as well as patient education in terms of how liability is handled by Medicare."
Delayed or lost payments
The goal of MSPQ is "to get the right information on the questionnaire before the claim goes out the door," says Reason. "Medicare’s goal is to make sure no one else is responsible to pay the bill."
Willis warns that if staff members capture the wrong information for MSPQ, or determine the incorrect payer order, "it will most certainly result in delays in payment of receivables." In addition, incorrectly labeling Medicare as the patient’s primary insurance, or missing payers that are primary to Medicare, often costs facilities greater reimbursement.
"Failing to identify the proper, primary payer will result in incorrect payments, accounts improperly labeled closed, and loss of that money when the error is discovered by the party that improperly paid primary," says Willis.
He says that "potentially millions" in revenue are at stake, and he adds that receiving improper commercial payments primary to Medicare often results in that payer recouping its payment beyond the timely filing parameter for the Medicare program. "This will leave the hospital with no one from whom to seek reimbursement," says Willis. "Medicare is then no longer liable for payment; nor is the patient."
Staff members often simply read the questions to patients and note the responses. However, says Willis, an MSPQ is not meant to be used as a document to dictate the patient’s response to the questions.
"The MSPQ is a tool to make staff aware of that which they need to elicit from the patient," he explains. "Staff must understand each question and be able to present them in a way that each patient fully grasps the meaning." (See related stories on training approaches for MSPQ completion, p. 118, and how MSP questions can be complex, p. 119.)
Break it down
Each question within the MSPQ must be "broken down to its essentials" and explained to staff members responsible for getting the answers, says Willis. No one should administer a questionnaire without a thorough understanding of each question’s meaning and its impact, he emphasizes. "Compliance is at stake. The success of the revenue cycle is at stake," says Willis.
Patient satisfaction is also a factor. "No one enjoys being asked complex questions, particularly when being asked by someone that doesn’t understand the purpose of the question or its importance," says Willis.
Reason says MSPQ errors are "first and foremost a customer satisfaction issue." Patients receive multiple statements from medical providers, as well as the explanation of benefits from Medicare and other payers. "All the paperwork can become confusing. MSP errors compound that confusion," says Reason.
SOURCES
- Patrick Burke, Training and Quality Control Auditor, Registration Services, Children’s Hospital Medical Center, Cincinnati. Phone: (513) 636-0230. Fax: (513) 636-1751. Email: [email protected].
- Kristy Fazzio, Quality Control Auditor, Registration Services, Children’s Hospital Medical Center, Cincinnati. Phone: (513) 803-6411. Fax: (513) 636-1751. Email: [email protected].
- Elizabeth Reason, MSA, CHAM, Patient Access and Pre-Service Director, Cleveland County HealthCare System, Shelby, NC. Phone: (980) 487-7471. Fax: (980) 487-7416. Email: [email protected].
- Kevin Willis, Claim Services, Harrison, OH. Phone: (866) 496-8278. Email: [email protected].
