Hospitals are now free of the Medicare as secondary payer (MSP) questionnaire as long as they do electronic insurance verification and ask patients whether their insurance has changed when they’re admitted as inpatients or register as outpatients. Medicare Transmittal 123, which took effect on Nov. 20, 2018, now refers to the MSP questionnaire as a “model,” and makes it optional.
In fact, CMS doesn’t want hospitals to annoy patients, assuming they can get Medicare primary and secondary payer information elsewhere.
“The MSP questionnaire is one of those antiquated policies they finally did away with,” says Stephen Gillis, director of compliance coding, billing and audit at Partners HealthCare in Boston. “That transmittal says if I ask the question, ‘Are there any changes to your insurance?’ and the answer is no, it’s pencils down,” he explains. “It’s one less thing to do.”
Although the MSP questionnaire made sense 10 or 15 years ago, CMS and hospitals now have “tremendous insurance verification capability and coordination of benefit capability,” he explains.
CMS: Document that Questions Were Not Asked
The MSP questionnaire is used to determine whether Medicare is the primary or secondary payer. If another insurer is primary, it pays the lion’s share of the patient’s bill, and Medicare covers the rest. Until Nov. 20, hospitals and other providers were required to ask Medicare patients the questions, and MACs had to audit them for completion of the questionnaire, although there were no penalties for noncompliance, Gillis says.
In recent years, however, CMS has been able to accumulate more information on whether Medicare is primary or secondary payer and has made that information available via the common working file (CWF) or HIPAA Eligibility Transaction System (HETS) Health Care Eligibility Benefit Inquiry and Response (270/271) Transaction Set.
Nothing has changed about the need to know the information. “Prior to submitting a bill to Medicare, you must determine whether Medicare is the primary or secondary payer for each beneficiary’s inpatient admission or outpatient encounter by asking the beneficiary about any other insurance coverage that may be primary to Medicare,” CMS says in a related MLN Matters (10863), which explains the transmittal.
But CMS says it’s “clarifying” the process. “If you have access to the Common Working File (CWF), your admission staff may ask the beneficiary if any insurance information it contains has changed. If there are no changes to the beneficiary’s insurance, then there is no need to ask the questions. However, if insurance information has changed, you must ask the MSP questions.” For auditing purposes, providers have to document that the questions were not asked if beneficiaries say their insurance information is unchanged, CMS adds.
Insurance Change Is the Key Question
Hospitals also can determine whether Medicare is primary or secondary on the HETS Health Care Eligibility Benefit Inquiry and Response (270/271) Transaction Set, which is used to transmit Health Care Eligibility Benefit Inquiries from health care providers, insurers, clearinghouses and other health care adjudication processors, CMS said. If there are no changes to insurance, there’s no reason to ask the beneficiary questions, but hospitals must ask questions if there are changes. “Further, you need to notate (for auditing purposes) that all the questions were not asked upon admission based on the beneficiary’s statement that their insurance information has not changed as your MAC may request this notation and confirmation during its hospital review,” CMS said.
Apparently Medicare is comfortable enough relying on its own systems to identify primary and secondary payers, Gillis says. The important message for compliance officers to get to billers and registration is that they have to ask patients whether insurance has changed because that might change Medicare’s status as secondary or primary.
Or hospitals are free to continue to use the MSP questionnaire. Ditching it is not required.
Patients will appreciate the end of mandatory questionnaires because sometimes when they return to the hospital the next day or shortly after treatment, they get frustrated at having to answer the same questions again, Gillis says.
Contact Gillis at sjgillis@partners.org. View the transmittal at https://go.cms.gov/2TVcmKg. ✧