Access Feedback: MSP ruling prompts questions,concerns
Continued re-asking’ is a problem
Denise Leapaldt, admissions supervisor for Jamestown (ND) Hospital, a 56-bed facility, offers feedback on two topics that were addressed in the July 2002 issue of Hospital Access Management.
The first issue, Leapaldt says, concerns Medicare Secondary Payer (MSP) questions and the new ruling that MSP information may be up to 90 days old for reference lab claims. "I agree that monitoring the MSP questionnaires for up-to-date information is tedious and cumbersome," she adds, "but I believe that being able to use 90-day-old information is much better than having to obtain new answers to the same questions for each reference lab."
"I maintain a manual database for all Medicare patients having nonpatient labs," Leapaldt says. "Many times, the lab patient has a nearly corresponding date of service at our hospital for another service, so the MSP information from the outpatient/inpatient account is current. I document the date that the initial MSP information was obtained, the date it will be nullified, the account from which I am taking the information, and the name of the person who supplied the MSP information."
One of her biggest complaints with continuous re-asking of MSP questions is explained by the following example: The patient is an 85-year-old widow at a local nursing home. She routinely has reference labs sent to the hospital for a diagnosis of high-risk meds. She never has suffered from black lung disease or end-stage renal disease. This test is not due to an injury. She has no Veterans Affairs (VA) insurance, and she is not involved with a government project where that agency would pay the claim. Obviously, she is entitled to Medicare because of her age. A previous MSP questionnaire states that she never worked outside the home, so she has no retirement date. She is a widow; so there is no spouse’s retirement date.
"What is ever going to change for this patient unless her claim involves injuries due to a motor vehicle accident or liability?" Leapaldt asks. "We receive the reference lab claims for her with a diagnosis that is obviously not due to an injury. What else would change? Is she suddenly going to have VA insurance? No. Will she ever be entitled to Medicare because of end-stage renal disease or a disability? No. Is she going to begin a career sometime soon, retire, and now have a retirement date? No."
Leapaldt once interviewed a patient twice in one day, and when asked the retirement date, the patient gave dates that differed by five years. Is this accurate information? After all, the patient verbally gave two different dates.
Repeatedly asking family members or patients for answers to these questions is time-consuming for registration employees and often irritating to the patients’ families. "We consistently hear, Nothing has changed,’ or We just gave you that information a few days ago,’" she says. "I advise my staff to tell families, I’m sorry, but we are required to ask these questions each and every time you come to the hospital. If you would like to protest this practice, please write to your congressman."
Leapaldt says that in an ideal world, hospital registration people would be trained to recognize the scenarios described above, and could register that nursing home patient accordingly but currently are unable to do so because of MSP rules.
"Unfortunately, in the past, facilities filing fraudulent claims have necessitated the formation of rules that hamper quick and efficient registration processes for the rest of us," she says. "We do everything we can to ensure that the claim is filed correctly, such as obtaining copies of insurance cards, verifying insurance coverage, and making necessary phone calls to question the reason for the patient’s visit."
The people making the rules regarding MSP questions should visit a hospital registration area and witness the difficulties encountered when trying to obtain correct MSP information, Leapaldt suggests. "More often than not, it is frustrating and unsuccessful, resulting in phone calls to the patient’s relatives who live elsewhere," she explains. "Do the relatives know if the patient has VA insurance? Do they have any idea of that patient’s retirement date? The answer to both is a resounding no."
Regarding another access issue — the challenge registration employees face in getting consent for admission forms signed — Leapaldt shares a solution her facility devised with its obstetrics (OB) department.
Since OB patients arrive at all times during the day and night and the admissions department is not staffed between 11 p.m. and 6 a.m., she explains, the window of opportunity for a consent signature would be lost without the cooperation of the OB department.
"We pre-register all OB patients as soon as we know they are expecting," Leapaldt says. "This includes any patient who arrives for an OB ultrasound early in her pregnancy. Upon registering, we ask the patient if she intends to deliver at our hospital. If she says yes, we will pre-register her for an outpatient OB visit for a future date. We compile all registration paperwork in a colored folder [to indicate OB], send the folder to OB, and they keep the paperwork until the patient comes in."
Most OB patients make an outpatient visit or two for one reason or another, and all OB patients are instructed by their physicians to go to the OB department — bypassing admissions — when they come to the hospital, she points out. "The OB staff perform the registration process, obtains the signatures, verifies the face sheet information, and sends the necessary paperwork to admissions, where the registration is completed."
If the visit was an outpatient visit, Leapaldt adds, a new folder is compiled and sent to OB for the patient’s next visit. This continues until the patient delivers, at which point the outpatient OB account is changed to an inpatient account.
"This has worked very well for out facility, and we appreciate the cooperation of the OB staff," she says. "Their willingness to perform registrations has eliminated a lot of follow-up telephone calls for consents and demographic information."
[Editor’s note: To respond to Leapaldt’s comments or to offer feedback on another access issue, please contact editor Lila Moore at (520) 299-8730 or at [email protected].]
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