In revenue cycle management, expertise in specific CMS tools is crucial to protecting revenue. The MSPQ is a key tool in the process of ensuring claims are paid by the appropriate payor the first time.
What is the MSPQ?
The Medicare secondary payor questionnaire (MSPQ) is a tool designed by the Centers for Medicare & Medicaid Services (CMS) to determine if Medicare is the primary or secondary payor in each patient case. 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.
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What does the MSPQ do?
Proper completion of the MSPQ prevents Medicare denials for services when 
a patient has another health insurance that is the primary payor. Both the order in which the questionnaire is answered along with the proper completion of each section are vital. Incomplete sections or answers or those in improper order could result in delay of payment, which can sometimes be substantial.
What timeline is important for the MSPQ?
A completed 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 occurs.
What are the parts of the MSPQ?
The MSPQ consists of six sections. Depending upon the patient status,
completion of each section may not be required.
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 Affairs 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 needs to be completed only 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 concerns eligibility based on age and asks whether the patient is employed and whether the patient’s spouse (as applicable) is employed. If the patient answers “no” to both questions, then Medicare is the primary payor. However, a patient can be on Medicare if they are still employed
Part V establishes eligibility based on disability and asks whether the patient is employed, whether the patient’s spouse (as applicable) is employed, whether the patient has group health plan coverage from the patient’s or spouse’s employment, and whether the patient has coverage under the group health plan of a non-spouse family member. If the patient answers “no” to all questions, then Medicare is the primary payor. Disability is not always permanent, so checking eligibility days in tandem with MSPQ is crucial.
Part VI verifies eligibility based on a diagnosis of ESRD. If the patient is covered under a group health plan, Medicare will be the secondary payor. If the patient is not covered under a group health plan, then Medicare is the primary payor. It is important to answer the remaining questions regarding the 30-month coordination period to determine if Medicare will be changed to the primary payor.
MSPQ | What Else?
The Common Working File for the beneficiary should always be checked to ensure that correct insurance is billed. If the beneficiary has health coverage other than Medicare, an accurate MSPQ must be 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 a reduction in denials and timely claim payments by the correct payor.
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