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CMS clarifies regulation
Hospitals no longer are required to collect Medicare Secondary Payer (MSP) information where there is no face-to-face encounter with a beneficiary, thanks to a recent clarification by the Centers for Medicare & Medicaid Services (CMS). The change, which was effective Aug. 16, 2004, is because independent reference laboratories no longer need the information to bill Medicare for reference laboratory services.
Section 943 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) states:
"[T]he secretary shall not require a hospital [including a critical access hospital] to ask questions [or obtain information] relating to the application of section 1862(b) of the Social Security Act [relating to Medicare Secondary Payer provisions] in the case of reference laboratory services described in subsection (b), if the secretary does not impose such requirement in the case of such services furnished by an independent laboratory."
Before the enactment of MMA, hospitals were required to collect MSP information every 90 days in order to bill Medicare for reference lab services.
The change brings relief to access managers who have long complained about the impracticality of complying with the requirement.
Sean Campbell, director of patient financial services at South Coast Hospital in Laguna Beach, CA, says the change has made the intake process and billing for specimens much easier for his facility. "We receive a lot of specimens," he adds. The physician community was not forthcoming in terms of sending over information on whether Medicare was the primary payer, Campbell notes. "Since the lab would come and we didn’t have the physician to ask, we had to contact the patient after the fact [to ask the MSP questions]," he says. The step delayed billing, Campbell says, and required staff to make a call that otherwise would not be necessary, since they were sent other patient information. "Just eliminating that [requirement] has given us the ability to have a more efficient operation," he says. "We take the specimen, bill for the service, and don’t have to worry about the compliance issue."
Repeated questions are frustrating
Other complaints centered on the continuous re-asking of MPS questions of beleaguered patients whose answers had no chance of varying, as with nursing home residents who routinely have reference labs sent to a hospital to monitor a particular condition.
One Hospital Access Management reader told of having to repeatedly ask such elderly patients — or their family members — whether they had ever had black lung disease, currently had Veterans Administration insurance, or were involved with a government project that would pay the claim, despite their being long-term nursing home residents who obviously were entitled to Medicare coverage.
On the other hand, some access managers were concerned that a relaxation in 2002 of the frequency with which the MSP questionnaire must be signed for reference laboratory accounts could put hospitals at risk of inadvertent violations. "We don’t have a mechanism to know when the 90 days have expired and that the services the patient is receiving for the current visit apply to the MPS questionnaire on file," one reader pointed out in a July 2002 Access Feedback column.