Expertise in Medicare and Medicaid services within revenue cycle management is critical to the financial outcomes of any facility. The MSPQ is a component in the overall process to optimize the timely and accurate payment of claims.
By: Mindy Singer, Donna Tarsa and Samantha Geroli
Medicare secondary payor questionnaire (MSPQ) is a tool designed by the Center for Medicare and Medicaid Services (CMS) to determine if Medicare is the primary or secondary payor in each patient case. The proper completion of the MSPQ prevents Medicare denials for services when a patient has another health insurance that is the primary payor. The order in which the questionnaire is answered is vital along with the proper completion of each section. Incomplete sections or answers or those in improper order could result in delay of payment, sometimes substantial delays.
What timeline is important for the MSPQ?
The MSPQ is designed to have a shelf life of 90 days, at which point it should be reviewed for any necessary corrections. However, an MSPQ could require correction prior to 90 days if a life changing event happens. Although the MSPQ can be difficult to complete, it is essential to the patient registration process and, ultimately, to the complete revenue cycle management process.
What are the parts of the MSPQ?
Part I distinguishes why the patient is receiving Medicare benefits:
- Is the patient receiving black lung benefits?
- Is the patient taking part in a government research program?
- Does the patient have Department of Veteran Affair (DVA) authorization?
- Are the services related to an accident/condition due to a work-related incident? If yes, these services will be covered by that payor and not sent to Medicare for any payment.
Part II only needs to be filled out if the illness/injury is due to a non-work-related accident.
Part III determines why the patient is entitled to Medicare, based on age, disability, or end stage renal disease (ESRD).
Part IV- Age is directly related to the patients’/spouses’, employment/retirement status. It is important to complete this section correctly to determine if Medicare will be the primary or secondary payor. If the patient answers no to both questions, then Medicare is the primary.
Part V- Disability is directly related to the patients’/spouses’, employment/retirement status. It is important to complete this section correctly to determine if Medicare will be the primary or secondary payor. If the patient answers NO to all questions, then Medicare is the primary.
Part VI- End Stage Renal Disease (ESRD) is if the patient is covered under a Group Health Plan, Medicare will be the secondary. If the patient is not covered under a Group Health Plan, then Medicare is the primary. It is important to answer the remaining questions regarding the 30-month coordination period to determine if Medicare will be changed to the primary.
Remember to always check the Common Working File for the beneficiary to ensure that correct insurance is billed. If the beneficiary has health coverage other than Medicare, ensure an accurate MSPQ is obtained to determine which payor is primary.
CMS can also place fines on an individual or organization that knowingly submits inaccurate health insurance information. Proper and accurate completion of the MSPQ is vital to timely claim payments by the correct payor and a reduction in denials. For more information on MSPQ or additional expertise on enhancing operational or financial outcomes for your hospital or health system, contact JTS Health Partners.
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