Go beyond normal audits of MSP data
Many reimbursement dollars may be lost if patient access fails to obtain accurate information on whether a patient has another form of insurance that will supersede Medicare during the registration process. Medicare Secondary Payer (MSP) requirements are one of many ever-increasing demands put on front-end staff, says Jennifer Nichols, director of patient access at Spectrum Health System in Grand Rapids, MI.
"Staff need to understand when and where to ask these questions, how to make sure the patient is answering the questions accurately, and how often to ask," she says. "Some of us are very lucky to have computer systems to help out with those tasks to a greater degree than others."
Staff must be sure they are getting the information correctly from the patient. "That means the patient has to understand the question clearly and know what they are providing," says Nichols.
However, many times, audits of MSP aren't comprehensive enough, according to Nichols. "Like everyone else, we do auditing of direct MSP questions and entry," says Nichols. "But one of the things that we have found in a large, complex health care system is that when you develop an auditing plan, you have to think beyond your source registration system."
The issue is that the MSP data may be captured or updated in other hospital systems. "If you interface this data anywhere, or if you have other systems that people may capture MSP data in, you have to be thinking holistically about having an integrated approach to that kind of auditing," says Nichols.
Spectrum Health's registration system is where all MSP entries are done, and there is also a billing system that has the capability to hold MSP information. "You could have a situation where a biller is getting updated information on MSP," says Nichols.
You would not want them to enter that information into a system that does not interface with your registration system, explains Nichols.
The idea is to go beyond just auditing to see whether the MSP information was obtained, which is all that is technically required for billing. "You need to be thinking about whether there are situations where your billers might need to update that information," says Nichols. "How do you provide a system or process to support that?"
In a hospital, you may have many systems with the ability to gather MSP information, and many departments that need to know that the MSP information has been gathered, and maybe even what the answers are.
"So when you think through an audit process, think through all your integration points for MSP data," says Nichols. "Have a comprehensive audit program for all those touch points. If you only audit your primary registration system, consider that you are actually sending this data to other systems and it could be changed there."
You are at a compliance risk if there is different information in billing and registration systems, adds Nichols. "And you may be missing a whole series of people who could be capturing and updating that information," she says.
[For more information, contact:
Jennifer Nichols, Director, Patient Access, Spectrum Health System, Grand Rapids, MI. Phone: (616) 391-1774. E-mail: [email protected].]
Many reimbursement dollars may be lost if patient access fails to obtain accurate information on whether a patient has another form of insurance that will supersede Medicare during the registration process.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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