Medicare Compliance & Reimbursement

MSP modifications could bring big changes.

The last thing a lab needs is to be singled out by the Centers for Medicare and Medicaid Services for sloppy Medicare secondary payer (MSP) collection practices.

The Medicare Modernization Act (MMA) changed the rules for what labs must collect, but the new guidance doesn't affect face-to-face encounters, such as when a client shows up for her thyroid screen.

Before labs launch into a service, they must determine whether the patient has an insurance option outside of Medicare, says Lisa Lounsbury, a data analyst with the Vascular Diagnostics Laboratory at Fletcher Allen Health Care in Burlington, VT.

Best bet: Use a questionnaire to cover all potential payment bases, suggests Lena Robins, senior counsel with Foley & Lardner in Washington, DC. Labs can either create their own forms or use the one CMS provides.
 
Regardless of the medium, a lab must ensure that staffers ask each relevant question - and that patients provide thorough answers.

Try this: A lab might consider breaking long questionnaires into sections, then telling its staffers to ask introduction questions that will signal which portion of the form must be filled out. Here are some great tell-tale questions that will make collecting MSP information easier:
   Are you currently employed?
   Is your spouse currently employed?
   Is your visit due to a work-related illness or injury that's covered by worker's compensation?
   Is your visit due to an illness or injury covered by auto insurance, no-fault insurance, medical payments coverage, personal injury insurance, liability insurance or a legal settlement?
   Do you have an illness or injury for which someone else could be held liable?
   Are you receiving Federal Black Lung Program benefits? Labs do not have to go through the entire questionnaire at each subsequent visit, Robins says. Rather, they can simply ask patients if their insurance information has changed. If it has, that's a signal that someone should collect more MSP information.

"If you leave something off that could indicate to Medicare that there's another payer, you could be subject to fines," Robins explains.

CMS is standing firm on MSP data collection because by billing other insurers first, the agency can cut its already enormous costs - which means better coverage for beneficiaries. And while Medicare could recover the cost for a service from another insurer after the fact, repeated MSP mistakes could warrant unwanted agency scrutiny on a lab's billing practices.

Read more about MSP obligations at www.cms.hhs.gov/manuals/pm_trans/R228CP.pdf.