When it comes to patient registration, there is a perpetual conflict between speed and accuracy vs. service. “Customer satisfaction is job one,” says Kevin Willis, director of Medicare services at Aurora, IL-based Claim Services Inc.
Nowhere is this more apparent than with the Medicare as Secondary Payer Questionnaire (MSPQ). The MSPQ dates back to the 1980s and has changed little since then.
“It always struck me that it was fashioned by government attorneys who decided to include every possible question they could think of,” Willis says. As a result, the MSPQ can create more questions than answers.
“It’s been augmented a word here or there over the decades. But the MSPQ is, at best, a clumsy document that people in the industry don’t understand,” Willis says.
Not Quick Enough
Some registrars are especially diligent when it comes to completing the MSPQ. However, they are not rewarded for it. Instead, these conscientious employees face low productivity metrics and complaining patients.
“That person is less popular because they are not turning over patients quickly enough,” Willis explains. Not surprisingly, some registrars seek shortcuts to please patients and higher-ups. This sometimes leads to the question “Is this service a result of a nonwork-related accident?” An affirmative response to this inquiry does not, by itself, reveal a payer primary to Medicare. “Its design is to reveal the need for additional questioning,” Willis notes. If the patient answers “yes,” that only leads to more questions and an even longer process.
To stop this from happening, some registrars head patients off at the pass by warning them what is in store. “When the patient says ‘yes,’ the registrar will return fire by saying, ‘If you say yes to that, we have to ask you more questions,’” Willis says.
A People Skill
The biggest mistake made by registrars? Reading the questions to the patient. “Like chess, it’s never the same game twice,” Willis says. “It is a people skill, not a reading skill.”
Just like the registration process, the MSPQ is different every time. “You need to understand the person you are talking to and present the information needed to that particular patient,” Willis advises.
Also important: Understand the purpose of the questions. This makes it painfully clear that the patient is not necessarily the best source of information. “There’s lots of cases where the patient is a poor resource. You have to be leery of that,” Willis warns.
Every patient’s situation is somewhat different. The way one asks the MSPQ questions should reflect this.
“We are interviewing the patient in the moment,” Willis underscores. “We are not capturing historical data; we are capturing data as it pertains to today.”
Auditors are not concerned with where the information came from; they only care if the information is correct. “If I were to audit you, I can hold you accountable for one thing, and that is having incorrect answers,” Willis says.
One cannot hide bad information from auditors. “The claim you submit to Medicare always reveals the hospital’s mistakes,” Willis notes. It is unnecessary to prove the wrong insurance was billed, only that the MSPQ and the submitted claim do not match.
One common example stems from registrars’ assumption that patient preferences dictate the proper payer order. This is not the case. Patients may say, “I don’t want you to bill my Medicare. I want you to bill this insurance because I earned it” or “I want you to bill this because it’s a self-funded plan through my husband’s company and I want him to pay my medical bill.”
“This trips folks up because they think they’ve got to do what the patients ask,” Willis says. “But patients do not dictate the proper payer order; Medicare does.”
Real-life examples are the best way to help registrars navigate MSPQ smoothly.
“Ask them, ‘What responses have you gotten from patients and you just had no idea what to do?’” Willis suggests.
Then, walk the registrar through the solution to that particular response. Often, registrars are told about their mistakes but are not given an opportunity to learn how to avoid those mistakes. “There has to be back and forth. They are just going to tune you out otherwise,” Willis suggests.
Patient financial services can be a tremendous resource.
“There is no way to impart to a registrar how the information is used without knowing who is using it,” Willis says. The back end is well acquainted with the misery that comes from a poorly completed MSPQ. However, front-end staff often do not understand.
“There’s a lot of blame game. Part of it has to do with the enormous separation between registration and patient financial services,” Willis offers.
The two departments may be led by separate executive directors, and front-line employees may not interact much. In reality, says Willis, “the two are linked — not just with Medicare, but with everything.”
Knowing the reason for MSPQ’s importance is essential. “Everyone wants patients happy. But that’s not the only thing that keeps the hospital healthy,” Willis explains. “We don’t have to read the questionnaire to the patient. We have to understand the questionnaire, and capture the information.”
There is a perpetual conflict between speed and accuracy vs. service. Nowhere is this more apparent than with the Medicare as Secondary Payer Questionnaire, what one experts calls "at best, a clumsy document" that confuses and frustrates patients and healthcare providers alike.
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