Medicare Secondary Payer Questionnaire Medicare Secondary Payer Questionnaire

Medicare Medicare Secondary Secondary Payer Payer QuestionnaireQuestionnaire

Annette  Yanna  Annette  Yanna  Senior System AnalystSenior System AnalystBaycare Health System, Clearwater, FloridaBaycare Health System, Clearwater, Florida

Dale  Sahlberg  Dale  Sahlberg  Senior System AnalystSenior System AnalystBaycare Health System, Clearwater, FloridaBaycare Health System, Clearwater, Florida

What is SIGNATURE ?What is SIGNATURE ?

SIGNATURE is an integrated outpatient SIGNATURE is an integrated outpatient management & outpatient accounting application.management & outpatient accounting application.

Front-office functions include registration, Front-office functions include registration, scheduling and report writing tools.scheduling and report writing tools.

Business office functions manage accounts Business office functions manage accounts receivables with collection tools to maximize receivables with collection tools to maximize reimbursements.reimbursements.

Has advanced collection tools (target files) to maximize allowable Has advanced collection tools (target files) to maximize allowable reimbursements based on payers and collectorsreimbursements based on payers and collectors

Generates 1505 medical billing claim forms (combined charge for Generates 1505 medical billing claim forms (combined charge for services and physician - example: chest X-ray)services and physician - example: chest X-ray)

Produces UB04s - same as an inpatient hospital bill with surgery Produces UB04s - same as an inpatient hospital bill with surgery billing for nurse, facility and supplies ( surgeons do their own billing )billing for nurse, facility and supplies ( surgeons do their own billing )

Has a combined Patient Management and Patient Accounting Has a combined Patient Management and Patient Accounting database (integrated application) that allows charges to be entered database (integrated application) that allows charges to be entered and bills produced that same day (day-end)and bills produced that same day (day-end)

Utilizes SCHEMES that allow multiple insurance plans to meet the Utilizes SCHEMES that allow multiple insurance plans to meet the different ambulatory care needsdifferent ambulatory care needs

The Siemens enhanced The Siemens enhanced

SIGNATURESIGNATURE version version employs browser technology employs browser technology called called OAS GOLD.OAS GOLD.

The original The original SIGNATURE SIGNATURE application was based on a application was based on a 3270 terminal design.3270 terminal design.

OAS GOLDOAS GOLD has new graphical features such as:has new graphical features such as:

check boxes, radio buttons, labels, selectable lines with check boxes, radio buttons, labels, selectable lines with banners, combo boxes, a calendar, text boxes, images, banners, combo boxes, a calendar, text boxes, images, scroll bars, data evaluators & controllers.scroll bars, data evaluators & controllers.

The Siemens The Siemens OAS GOLDOAS GOLD product enabled BayCare Health Systems to product enabled BayCare Health Systems to go greengo green and put online a long government document called the and put online a long government document called the

Medicare Secondary Payer Medicare Secondary Payer QuestionnaireQuestionnaire ( (MSPQMSPQ).).

An MSPQ is a 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 Secondary Payer (MSP) is the term used by Medicare when Medicare is not responsible for paying first. The private insurance Medicare is not responsible for paying first. The private insurance industry generally talks about "Coordination of Benefits" when assigning industry generally talks about "Coordination of Benefits" when assigning responsibility for first and second payment. 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 The Medicare Secondary Payer (MSP) program is designed to reduce costs to the Medicare program by requiring other insurers of health care costs to the Medicare program by requiring other insurers of health care for beneficiaries to pay primary to Medicare. 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 100.05 Chapter 3, Section 20.2.1).

What is an MSPQ ?What is an MSPQ ?

MSPQ ManualMSPQ Manual

and manyand many more pages …more pages …

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

Medicare payment will be secondary or excluded when the following types Medicare payment will be secondary or excluded when the following types of insurance are available to cover health care costs:of insurance are available to cover health care costs: 1)1) Workers’ compensation Workers’ compensation 2)2) Automobile, no-fault, or liability insurance Automobile, no-fault, or liability insurance 3)3) Employer group health plans Employer group health plans

Individuals aged 65 and older:Individuals aged 65 and older:When a beneficiary aged 65 or older has employer group health coverage When a beneficiary aged 65 or older has employer group health coverage based upon active employment or the current employment of a spouse by based upon active employment or the current employment of a spouse by an employer with 20 or more employees, the beneficiary may choose an employer with 20 or more employees, the beneficiary may choose Medicare or the employer-based plan as the primary insurer.Medicare or the employer-based plan as the primary insurer.

Individuals under age 65:Individuals under age 65:Medicare is the secondary payer for beneficiaries who are entitled to Medicare is the secondary payer for beneficiaries who are entitled to Medicare based on disability and are covered by a large group health plan 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) through their active employment or that of a family member. An LGHP is sponsored by an employer who normally employs at least 100 full- 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 or part-time employees on at least 50 percent of the regular business days in the preceding calendar year.the preceding calendar year.

MSPQ ManualMSPQ Manual - - interpretation in plain Englishinterpretation in plain English

Medicare Secondary Payer Medicare Secondary Payer Questionnaire (MSPQ)Questionnaire (MSPQ)

PROJECT PROJECT GOALSGOALS

#1:#1: Improve AccuracyImprove Accuracy

#2:#2: Improve EfficiencyImprove Efficiency

Government Government MSPQ manual – MSPQ manual – complex complex instructionsinstructions

Hospital MSPQ Hospital MSPQ paper documentpaper document

=+

Medicare Secondary Payer Medicare Secondary Payer Questionnaire (MSPQ)Questionnaire (MSPQ)

NewNewOnlinOnlineeMSPQMSPQ

#1:#1: Improve AccuracyImprove Accuracy

Information Information sent to the sent to the Financial Financial SystemSystem

Medicare Secondary Payer Medicare Secondary Payer Questionnaire (MSPQ)Questionnaire (MSPQ)

Change this Change this type of type of screenscreen

DynaDynamicmicMSPQMSPQscreescreenn

#2:#2: Improve EfficiencyImprove Efficiency

to a New Type ofto a New Type of Registration Registration Screen Screen

How important to How important to hospitals is hospitals is Medicare ?Medicare ?

How important is How important is Medicare to Medicare to

??

FLORIDAFLORIDA

FLORIDAFLORIDA

How important is How important is Medicare to Medicare to

??

20092009

First page of a paper First page of a paper Medicare Secondary Payer Medicare Secondary Payer Questionnaire Questionnaire ::

and manyand many more pages …more pages …

Is there a way to take all Is there a way to take all the complex instructions the complex instructions from the government from the government MSPQ manual …MSPQ manual …

and can there be an and can there be an online MSPQ version that online MSPQ version that is easier to fill out than is easier to fill out than the long paper the long paper document ?document ?

and simplify the work of and simplify the work of figuring out what to answer figuring out what to answer on the questionnaire …on the questionnaire …

+

+

Online form scrolls down.

AGE panel

ESRD panel

DISABILITY panel

Main panel

Full Full VersionVersion

Ensuring that Ensuring that the MSPQ is the MSPQ is

filled out filled out correctly is correctly is important.important.

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.

Example of a question that has other linked fields dependent on a YES or NO answer:

IF the answer to   

is NOthen the boxes below that should NOT be filled out are automatically GRAYED out to prevent inaccurate and unnecessary data entry.

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

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

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

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

This AGE panel will show for patients 65 and older.

The ESRD panel is optional.   

The DISABILITY panel will be “grayed out” and not allow any data entry.

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

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

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.   

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

• In addition to the interactive edits that take a user through each In addition to the interactive edits that take a user through each panel, there is also an panel, there is also an MSPQMSPQ fact sheet derived from the fact sheet derived from the government Medicare website that can now be viewed online in a government Medicare website that can now be viewed online in a HELP panel.HELP panel.

• In this example, the user clicks the “In this example, the user clicks the “hot spothot spot” for help …” for help …

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

The panel “The panel “fact sheetfact sheet” larger screen view …” larger screen view …

Fact sheet scrolls down.

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

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:

A button displays local cities and there is help for all USA zip codes as well:                        

The has a drop down for quick selections:

Staff can find International or Canada zip codes.                     

There are options to search for any USA city or zip code.               

80% of patients are from these zip codes.             

Listed are all the zip codes for:                         

… the system will automatically fill in the CITY, STATE and ZIP CODE.                         

After selecting a line …                        

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

Modus Operandi

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

INVISION

INVISIONModus Operandi

Medicare Secondary Payer Medicare Secondary Payer Questionnaire (MSPQ)Questionnaire (MSPQ)

From:From: Gray, Candace Gray, CandaceSent:Sent: Mon 6/29/2009 1:01 PM Mon 6/29/2009 1:01 PM

Subject:Subject: MDH, NBH and SAH Planned Medicare Audits MDH, NBH and SAH Planned Medicare Audits

As many of you already know, we had 3 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 today.  The audits were focused on our compliance with Medicare’s Secondary Payer requirements.  Today’s audits were for Mease Secondary Payer requirements.  Today’s audits were for Mease Dunedin, North Bay and St. Anthony’s Hospitals.  I want to personally Dunedin, North Bay and St. Anthony’s Hospitals.  I want to personally congratulate and thank everyone involved in the success of the congratulate and thank everyone involved in the success of the audits. audits. 

Although the final audit report has not been completed, the auditor Although the final audit report has not been completed, the auditor had no preliminary recommendations for us and was pleased with had no preliminary recommendations for us and was pleased with the information provided.    He also commented how we should the information provided.    He also commented how we should market our product since our system works so well for transferring market our product since our system works so well for transferring information from our Medicare Secondary Questionnaire to our bill ! information from our Medicare Secondary Questionnaire to our bill ! 

UB04

IMPLEMENTATIOIMPLEMENTATIONN

PROCESSPROCESS

FOUR SIGNATURE REGIONSFOUR SIGNATURE REGIONS

St Joseph's Diagnostic Center … St Joseph's Diagnostic Center … 4 Imaging Sites4 Imaging Sites

Same Day Surgery … Same Day Surgery … 1 Surgery Center1 Surgery Center

Morton Plant Health Services … Morton Plant Health Services … 3 Imaging Sites3 Imaging Sites 1 OP Surgery / Endo site1 OP Surgery / Endo site

Baycare Ambulatory Care … Baycare Ambulatory Care … 3 Imaging Sites 3 Imaging Sites 2 St Anthony 2 St Anthony 1 Med Specialist1 Med Specialist 1 OP Surgery Site1 OP Surgery Site 5 Mental Health Sites5 Mental Health Sites

Analysis PhaseAnalysis Phase

Examined the government Examined the government MSPQMSPQ manual manual

Reviewed the current hospital paper Reviewed the current hospital paper MSPQ MSPQ documentdocument

Talked with registration staff about what Talked with registration staff about what questions were complex for patients to questions were complex for patients to answeranswer

Asked staff about further information they Asked staff about further information they needed to complete the form more needed to complete the form more efficientlyefficiently

CHALLENGESCHALLENGES

– Programming the system to guide users through every Programming the system to guide users through every panel using panel using GOLDGOLD tools such as the Data Pool Evaluator tools such as the Data Pool Evaluator

– Writing conditional logic to ensure questions that were Writing conditional logic to ensure questions that were linked to a previous key question were answered linked to a previous key question were answered

((example:example: Was this illness due to a work related accident ? Was this illness due to a work related accident ?))

– Providing Providing GOLDGOLD popup panels to give detailed instructions popup panels to give detailed instructions ((example:example: Is the patient having excluded services ? Is the patient having excluded services ?))

– Storing the MSPQ questions using a Storing the MSPQ questions using a 32703270 Profile PRHMQ Profile PRHMQ that has each completed online questionnaire tied to a that has each completed online questionnaire tied to a patient by the patient by the Patient Case IDPatient Case ID. .

– Displaying LINE 24 messages to help provide further Displaying LINE 24 messages to help provide further guidance.guidance.

((example:example: Please Select a Reason for Entitlement Please Select a Reason for Entitlement ))

Build PhaseBuild Phase Examined the current Examined the current

paperpaper MSPQ MSPQ documentdocument

Reviewed the Reviewed the government government MSPQ manualMSPQ manual

Created a Created a composite composite GOLDGOLD version of the version of the two two documentsdocuments

Testing PhaseTesting Phase

Completed an online Completed an online MSPQMSPQ and then and then compared the data to the government compared the data to the government MSPQMSPQ manual requirements for each Age, Disability and manual requirements for each Age, Disability and End Stage Renal Disease category.End Stage Renal Disease category.

Emulated real patient scenarios when typing Emulated real patient scenarios when typing in answers to the in answers to the MSPQMSPQ questions - checked for questions - checked for speed and accuracy.speed and accuracy.

Backup StorageBackup Storage

EDM (Electronic Data Management)

An electronic MSPQ document is sent to EDM.

Training Training PhasePhase

• ACBO – Ambulatory Care ACBO – Ambulatory Care Business office staffBusiness office staff

• PM – Patient Management PM – Patient Management registration staffregistration staff

Training sessions for:Training sessions for:

LIVE ImplementationLIVE Implementation

ACBO - Ambulatory Care BusinessACBO - Ambulatory Care Business

OfficeOffice Signature clinicsSignature clinics

Are there any questions ?Are there any questions ?

Thank you for attending this session.

Session #121An Interactive Online Medicare Secondary Payer Questionnaire (MSPQ) that Received a MedicareAuditors Commendation.

Please take a few moments to complete your evaluation form before you leave.