2 PRESENTED BYAnnette 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 FEATURESHas 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 ).
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.
24 First page of a paper Medicare Secondary Payer Questionnaire : and manymore 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 ?
27 Ensuring that the MSPQ is filled out correctly is important. Full VersionMain panelAGE panelDISABILITY panelEnsuring 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 tois NOthen 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 displayswhen the “hot spot”is clicked.
53 From: Gray, Candace Sent: Mon 6/29/2009 1:01 PM Subject: MDH, NBH and SAH Planned Medicare AuditsAs 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 !
55 IMPLEMENTATION PROCESS SIGNATUREOAS GOLDM S P QIMPLEMENTATION PROCESS
56 FOUR SIGNATURE REGIONS St Joseph's Diagnostic Center … Imaging SitesSame Day Surgery … 1 Surgery CenterMorton Plant Health Services … Imaging Sites1 OP Surgery / Endo siteBaycare Ambulatory Care … Imaging Sites2 St Anthony1 Med Specialist1 OP Surgery Site5 Mental Health Sites
57 Analysis Phase Examined the government MSPQ manual Reviewed the current hospital paper MSPQ documentTalked with registration staff about what questions were complex for patients to answerAsked staff about further information they needed to complete the form more efficiently
58 CHALLENGESProgramming the system to guide users through every panel using GOLD tools such as the Data Pool EvaluatorWriting 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 manualCreated a composite GOLD version of the two documents
60 Testing PhaseCompleted 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 staffPM – 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.