Transcript Medicare Secondary Payer Questionnaire Annette Yanna Senior System Analyst Baycare Health System, Clearwater, Florida Dale Sahlberg Senior System Analyst Baycare Health System, Clearwater, Florida What is SIGNATURE ? SIGNATURE is.

Medicare
Secondary Payer
Questionnaire
Annette Yanna
Senior System Analyst
Baycare Health System, Clearwater, Florida
Dale Sahlberg
Senior System Analyst
Baycare Health System, Clearwater, Florida
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.
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
The original SIGNATURE
application was based on a
3270 terminal design.
The Siemens enhanced
SIGNATURE version
employs browser technology
called OAS GOLD.
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.
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).
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).
MSPQ Manual
and many
more pages …
Below are some of the complex instructions for the MSPQ:
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 fullor part-time employees on at least 50 percent of the regular business days in
the preceding calendar year.
Medicare Secondary Payer Questionnaire (MSPQ)
PROJECT GOALS
#1:
Improve Accuracy
#2:
Improve Efficiency
Medicare Secondary Payer Questionnaire (MSPQ)
#1:
Improve Accuracy
Government MSPQ
manual – complex
instructions
Hospital MSPQ
paper document
+
=
New
Online
MSPQ
Medicare Secondary Payer Questionnaire (MSPQ)
#2:
Improve Efficiency
Change this
type of
screen
Dynamic
MSPQ
screen
to a New Type of
Registration Screen
Information
sent to the
Financial
System
How important to
hospitals is
Medicare ?
How important is
Medicare to
?
FLORIDA
FLORIDA
How important is
Medicare to
?
2009
First page of a paper Medicare Secondary Payer Questionnaire :
and many
more pages …
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 ?
Online
form
scrolls
down.
Full
Version
Main panel
AGE panel
DISABILITY panel
ESRD panel
Ensuring that
the MSPQ is
filled out
correctly is
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 NO
then 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 DISABILITY panel will be “grayed out”
and not allow any data entry.
The ESRD panel is optional.
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
message that one of
the three sub-panels
must be answered.
• 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 …
This panel displays
when the “hot spot”
is clicked.
The panel “fact sheet” 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
selections:
has a drop down for quick
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.
Listed are all the zip codes for:
After selecting a line …
… the system will automatically fill in the
CITY, STATE and ZIP CODE.
Can select MSPQ option. Also, the MSP Coverage Question panel
will automatically display for specific Outpatient Service codes.
Modus Operandi
INVISION
MSP Questionnaire
(Medicare)
will automatically display when the Financial Class is M
or click
option to access.
INVISION
Modus Operandi
Medicare Secondary Payer Questionnaire (MSPQ)
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 !
UB04
IMPLEMENTATION
PROCESS
FOUR SIGNATURE REGIONS
St Joseph's Diagnostic Center …
Same Day Surgery …
4 Imaging Sites
1 Surgery Center
Morton Plant Health Services …
Baycare Ambulatory Care
…
3 Imaging Sites
1 OP Surgery / Endo site
3 Imaging Sites
2 St Anthony
1 Med Specialist
1 OP Surgery Site
5 Mental Health Sites
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
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 )
Build Phase
Examined the current
paper MSPQ
document
Created a
composite
GOLD
version of
the two
documents
Reviewed the
government
MSPQ manual
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.
Backup Storage
 EDM (Electronic Data Management)
An electronic MSPQ document is sent to EDM.
Training Phase
Training sessions for:
• ACBO – Ambulatory Care
Business office staff
• PM – Patient Management
registration staff
LIVE Implementation
 ACBO - Ambulatory Care Business
Office
 Signature clinics
Are there any
questions ?
Thank you for attending this session.
Session #121
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.