MSPQ
Individual is age 65 or older,is covered by a GHP through current employment.The employer has less than 20 employees.What insurance is primary?
Medicare pays Primary, GHP pays secondary
What is an insurance overlay?
Insurance overlay occurs when coverage is added that does not belong to the patient. Looking at RTE responses is important to ensure the coverage belongs to your patient before adding the coverage.
What is the basic law of EMTALA
Any person who comes to the Emergency Department must undergo a medical screening examination by a qualified medical professional to determine if they have an emergency medical condition, in which case, they must be stabilized or appropriately transferred to another facility.
I have straight NC Medicaid. How much should you collect from me for my visit?
NOTHING!
What is your most used emoji and why? Each team member must answer.
laughing emoji for me :)
Individual has ESRD, is covered by a GHP and is in the first 30 months of eligibility or entitlement to Medicare.What insurance is primary andwhich is secondary?
GHP pays Primary, Medicare pays secondary during 30-month coordination period for ESRD
When do I use Account Activity 2751 (Medicaid Only) ? When can I use Account Activity 2757(BCBS only)?
2751 Medicaid Only: RTE Incorrect; Use this Account Activity when the RTE response from Medicaid indicates another payor exists or should be primary when the patient does not actually have another coverage
2757 BCBS Only: RTE incorrect; Use this Account Activity when the RTE response from BCBS indicates another coverage exists or should be primary when the patient does not actually have another coverage.
a patient is classified as an _______ when he is admitted due to illness or severe physical trauma that they are required to stay for at least one night while waiting for the completion of procedures or examination as ordered by the prescribing physician
Inpatient
What must you have if you verify an insurance by website?
If you are unable to find the insurance on one source, what can you do?
When verifying the insurance by website, you must copy the passport number from onesource. YOU MUST ADD AA1576! If you are unable to do this, please verify by card ONLY if the card is scanned in. If these are not an option, please reach out to your leaders if the insurance needs to be verified! PLEASE DO NOT USE VERIFIED BY PHONE UNLESS YOU DID CALL.
Two truths and one lie
I was a ballerina
I have never had a cavity before
My brother is a pilot
What does MSPQ stand for?
Medicare Secondary Payor Question
A patient will be filing Medico Insurance. After adding the coverage, I realize it is not RTE enabled. I get a contact payor response. What should I do to fix this error?
Go to onesource and search for the plan Medico. Add AA1576 andupdate insurance status to verified by website.
Within your group, sell me my chart and the importance of it.
MyChart allows patients to interact with their medical records, ensure financial success, schedule appointments with provider, e check in for visits, request a refill of medication,and see any upcoming visits.
You are telling a patient they have a coinsurance of $825. The patient states this is wrong. How can you reply?
Various acceptable answers, just do not argue with the patient :)
John's parents are divorced. His mother has custody of him. Both of his parent's work and have health insurance through their jobs. John is covered under both policies. John broke his arm and needed surgery. Which insurance will be primary?
The mom
A 70 year old patient was involved in a car accident. You are the registrar interviewing this patient. The patient also has Medicare. Explain what is no-fault or liability insurance to me and what insurance you will be filing as primary and which one as secondary?
No-fault or Liability Insurance pays primary for accident. Medicare pays secondary.
The amount you pay for covered health care services before your insurance plan starts to pay.
deductible
What is the scripting for collecting IM/MOON forms?
IM: “This document explains your rights as a Medicare inpatient and provides information on who to contact if you feel you are being discharged too soon.”
MOON: “This document explains your Medicare benefits for your observation stay.”
When adding any type of coverage, you must complete the Covered Through field. If a patient has more than one coverage, including Medicare, this field helps determine the correct filing order for the coverages. There are 4 available options:
• Other – use for government payors (Medicare, Medicaid, Tricare, Black Lung coverage, etc.), supplements, and
individual policies
• Current Employment – use for Group Health Plans (GHPs)
• Retirement – use only for retirement policies obtained through a former employer (NOT Medicare)
• COBRA/Continuation of Benefits – used for COBRA plans
Patient has CIGNA health insurance. He has a $1500 deductible which he has not paid anything toward yet this year, co-insurance 80-20. He had knee surgery and the hospital charges are $3400.
A. What amount is due from the patient?
B. What amount is due from the health plan?
Charges - deductible
$3400-$1500 = $1900
A. $1900 x 0.20 = $1880
B. $1900 x 0.80 = $1520
A patient comes into the Emergency Department. The patient has VA and Medicare. Which insurance is primary and which is secondary? Guide me on how I would answer the MSPQ questions for this patient.
YOU DONT!! The patient can only file one or the other!! If the patient is filing VA, YOU WILL NOT HAVE TO COMPLETE THE MSPQ :)
An insured mom gave birth to her sweet little girl. Her BCBS insurance is active. The plan has a $2,000 deductible which mom has not met and an 80/20 coinsurance clause. The delivery was $10,000. How much will the moms coinsurance be?
$10,000-$2,000=$8000
$8000x20%=$1600
$1600+$2000=$3600
Pick 1 member of the team to be a registar. Registrar will pick a PFS Leader to be the patient.
Ask your patient to verify demographics, add an emergency contact, employment status, insurance and PCP question.
:)
What is Supplemental Return?
The patient has an additional coverage that is primary. Search for it and add the coverage. Send another query for the primary plan.
FREE
FREE