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Medicare Secondary Payer Questionnaire

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Presentation on theme: "Medicare Secondary Payer Questionnaire"— Presentation transcript:

1 Medicare Secondary Payer Questionnaire
Signature Medicare Secondary Payer Questionnaire

2 PRESENTED BY Annette  Yanna  Senior System Analyst Baycare Health System, Clearwater, Florida Dale  Sahlberg  Senior System Analyst Baycare Health System, Clearwater, Florida

3 What is SIGNATURE ? SIGNATURE is an integrated outpatient management & outpatient accounting application. Front-office functions include registration, scheduling and report writing tools. Business office functions manage accounts receivables with collection tools to maximize reimbursements.

4 SIGNATURE FEATURES Has advanced collection tools (target files) to maximize allowable reimbursements based on payers and collectors Generates 1505 medical billing claim forms (combined charge for services and physician - example: chest X-ray) Produces UB04s - same as an inpatient hospital bill with surgery billing for nurse, facility and supplies ( surgeons do their own billing ) Has a combined Patient Management and Patient Accounting database (integrated application) that allows charges to be entered and bills produced that same day (day-end) Utilizes SCHEMES that allow multiple insurance plans to meet the different ambulatory care needs

5 The original SIGNATURE application was based on a 3270 terminal design.
The Siemens enhanced SIGNATURE version employs browser technology called OAS GOLD.

6 OAS GOLD has new graphical features such as:
check boxes, radio buttons, labels, selectable lines with banners, combo boxes, a calendar, text boxes, images, scroll bars, data evaluators & controllers.

7 The Siemens OAS GOLD product enabled BayCare Health Systems to go green and put online a long government document called the Medicare Secondary Payer Questionnaire (MSPQ).

8 What is an MSPQ ? An MSPQ is a Medicare Secondary Payer Questionnaire that lists all the questions Medicare has for a patient to receive coverage. Medicare Secondary Payer (MSP) is the term used by Medicare when Medicare is not responsible for paying first. The private insurance industry generally talks about "Coordination of Benefits" when assigning responsibility for first and second payment. In 1980, Congress enacted provisions that made Medicare the secondary payer to certain additional primary plans (group health plans, workers’ compensation plans, liability insurance, no-fault insurance). The Medicare Secondary Payer (MSP) program is designed to reduce costs to the Medicare program by requiring other insurers of health care for beneficiaries to pay primary to Medicare.  To help identify such Medicare Secondary Payer (MSP) situations, CMS (Centers for Medicare & Medicaid Services) has developed a Medicare Secondary Payer Questionnaire Manual (found in IOM Chapter 3, Section ).

9 MSPQ Manual and many more pages …

10 Below are some of the complex instructions for the MSPQ:

11 MSPQ Manual - interpretation in plain English
Medicare payment will be secondary or excluded when the following types of insurance are available to cover health care costs: 1) Workers’ compensation 2) Automobile, no-fault, or liability insurance 3) Employer group health plans Individuals aged 65 and older: When a beneficiary aged 65 or older has employer group health coverage based upon active employment or the current employment of a spouse by an employer with 20 or more employees, the beneficiary may choose Medicare or the employer-based plan as the primary insurer. Individuals under age 65: Medicare is the secondary payer for beneficiaries who are entitled to Medicare based on disability and are covered by a large group health plan (LGHP) through their active employment or that of a family member. An LGHP is sponsored by an employer who normally employs at least 100 full- or part-time employees on at least 50 percent of the regular business days in the preceding calendar year.

12 Medicare Secondary Payer Questionnaire (MSPQ) PROJECT GOALS
#1: Improve Accuracy #2: Improve Efficiency

13 + = Medicare Secondary Payer Questionnaire (MSPQ) #1: Improve Accuracy
Government MSPQ manual – complex instructions Hospital MSPQ paper document New Online MSPQ + =

14 Medicare Secondary Payer Questionnaire (MSPQ)
#2: Improve Efficiency Change this type of screen Information sent to the Financial System Dynamic MSPQ screen to a New Type of Registration Screen

15 How important to hospitals is
Medicare ?




19 How important is Medicare to



22 How important is Medicare to

23 2009

24 First page of a paper Medicare Secondary Payer Questionnaire :
and many more pages …

25 Is there a way to take all the complex instructions from the government MSPQ manual …
+ and simplify the work of figuring out what to answer on the questionnaire … + and can there be an online MSPQ version that is easier to fill out than the long paper document ?

26 Online form scrolls down.

27 Ensuring that the MSPQ is filled out correctly is important.
Full Version Main panel AGE panel DISABILITY panel Ensuring that the MSPQ is filled out correctly is important. ESRD panel

28 The MSPQ has advanced edits to aid a registration clerk with step by step guidance through the questionnaire.   This significantly improves the accuracy of the MSPQ. A is used to control the display of associated fields to a key question using conditional logic.

29 Example of a question that has other linked fields dependent on a YES or NO answer:
IF the answer to                                                                                                                           is NO then the boxes below that should NOT be filled out are automatically GRAYED out to prevent inaccurate and unnecessary data entry.

30 The cursor will jump to the next pertinent field to be answered:                                                                                                                                                  
Since that answer is YES the system will stop at each required field below for an answer: Required

31 Conditional logic in each associated field checks if an answer is required:

32 The MSPQ has pre-display logic to show AGE or DISABILITY panels based on the age of the patient.

33 If the person is over 65 then an AGE panel will display asking pertinent Medicare questions:                                                                                                                                                  

34 This AGE panel will show for patients 65 and older.
The DISABILITY panel will be “grayed out” and not allow any data entry. The ESRD panel is optional.   

35 If the person is under 65 years old then the AGE panel will be hidden and a message panel will display:                                                                                                                                                  

36 If the person is under 65 years old then the DISABILITY panel will display:                                                                                                                                                  

37 A message panel states that the patient is less than 65 years old.
The DISABILITY panel will automatically be open for data entry. The ESRD panel is optional.   

38 There is a warning message that one of the three sub-panels must be answered.

39 In addition to the interactive edits that take a user through each panel, there is also an MSPQ fact sheet derived from the government Medicare website that can now be viewed online in a HELP panel. In this example, the user clicks the “hot spot” for help …

40 This panel displays when the “hot spot” is clicked.

41 The panel “fact sheet” larger screen view …
Fact sheet scrolls down.

42 A search button shows what the government Medicare manual defines for excluded services.                                                                                                                                                  

43 Help for a key field is instantly available by holding the cursor over a title which will display a “hot spot” that shows a help screen when clicked:

44 A button displays local cities and there is help for all USA zip codes as well:                        
The has a drop down for quick selections:

45 Staff can find International or
Canada zip codes.                      80% of patients are from these zip codes.              There are options to search for any USA city or zip code.               

46 Listed are all the zip codes for:                         

47 After selecting a line …                        
… the system will automatically fill in the CITY, STATE and ZIP CODE.                         

48 Signature Can select MSPQ option. Also, the MSP Coverage Question panel will automatically display for specific Outpatient Service codes.

49 Signature Modus Operandi

50 INVISION MSP Questionnaire will automatically display when the Financial Class is M (Medicare) or click option to access.

51 INVISION Modus Operandi

52 Medicare Secondary Payer Questionnaire (MSPQ)

53 From: Gray, Candace Sent: Mon 6/29/2009 1:01 PM
Subject: MDH, NBH and SAH Planned Medicare Audits As many of you already know, we had 3 planned Medicare audits today.  The audits were focused on our compliance with Medicare’s Secondary Payer requirements.  Today’s audits were for Mease Dunedin, North Bay and St. Anthony’s Hospitals.  I want to personally congratulate and thank everyone involved in the success of the audits.  Although the final audit report has not been completed, the auditor had no preliminary recommendations for us and was pleased with the information provided.    He also commented how we should market our product since our system works so well for transferring information from our Medicare Secondary Questionnaire to our bill ! 

54 UB04


St Joseph's Diagnostic Center … Imaging Sites Same Day Surgery … 1 Surgery Center Morton Plant Health Services … Imaging Sites 1 OP Surgery / Endo site Baycare Ambulatory Care … Imaging Sites 2 St Anthony 1 Med Specialist 1 OP Surgery Site 5 Mental Health Sites

57 Analysis Phase Examined the government MSPQ manual
Reviewed the current hospital paper MSPQ document Talked with registration staff about what questions were complex for patients to answer Asked staff about further information they needed to complete the form more efficiently

58 CHALLENGES Programming the system to guide users through every panel using GOLD tools such as the Data Pool Evaluator Writing conditional logic to ensure questions that were linked to a previous key question were answered (example: Was this illness due to a work related accident ?) Providing GOLD popup panels to give detailed instructions (example: Is the patient having excluded services ?) Storing the MSPQ questions using a 3270 Profile PRHMQ that has each completed online questionnaire tied to a patient by the Patient Case ID. Displaying LINE 24 messages to help provide further guidance. (example: Please Select a Reason for Entitlement )

59 Build Phase Examined the current paper MSPQ document
Reviewed the government MSPQ manual Created a composite GOLD version of the two documents

60 Testing Phase Completed an online MSPQ and then compared the data to the government MSPQ manual requirements for each Age, Disability and End Stage Renal Disease category. Emulated real patient scenarios when typing in answers to the MSPQ questions - checked for speed and accuracy.

61 Backup Storage EDM (Electronic Data Management)
An electronic MSPQ document is sent to EDM.

62 Training Phase Training sessions for:
ACBO – Ambulatory Care Business office staff PM – Patient Management registration staff

63 LIVE Implementation ACBO - Ambulatory Care Business Office
Signature clinics

64 Are there any questions ?
This concludes our presentation. Are there any questions ?

65 Session #121 Thank you for attending this session.
An Interactive Online Medicare Secondary Payer Questionnaire (MSPQ) that Received a Medicare Auditors Commendation. Please take a few moments to complete your evaluation form before you leave.

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