Medicare Secondary Payer Questionnaire

1. Medicare Secondary Payer Questionnaire Signature

2. Annette  Yanna  Senior System AnalystBaycare Health System, Clearwater, FloridaDale  Sahlberg  Senior System AnalystBaycare Health System, Clearwater, Florida PRESENTED BY

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 collectorsGenerates 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 GOLDhas 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 100.05 Chapter 3, Section 20.2.1).

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’ compensation2) Automobile, no-fault, or liability insurance3) Employer group health plansIndividuals 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 ?

20. FLORIDA

21. FLORIDA

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. Full Version Ensuring that the MSPQ is filled out correctly is important. Main panel AGE panel DISABILITY panel 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 aYESorNOanswer: 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-displaylogic 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 Questionnairewill automatically display when the Financial Class is M (Medicare) or click option to access.