What may occur if the hospital sends claims without the MSPQ attached?

What may occur if the hospital sends claims without the MSPQ attached?

• A. The hospital may be fined
• B. The claim will be processed more quickly
• C. The patient may owe additional fees
• D. The hospital will receive a bonus

Answer: (A)

Sending claims without the Medicare Secondary Payer Questionnaire (MSPQ) can lead to significant issues for a hospital, primarily because the MSPQ provides essential information regarding whether Medicare is the primary or secondary payer for a patient’s services. If this information is not included with the claim, it can result in improper claim processing. Consequences of not attaching the MSPQ may include delays in payment, the claim being denied, or potential fines imposed on the hospital. The MSPQ helps ensure that the billing process is compliant with regulations and accurately reflects the patient's insurance status, preventing financial losses and maintaining the integrity of the claims process. Ultimately, adherence to these requirements safeguards the hospital against fines and administrative burdens associated with non-compliant billing practices.

Sending claims without the Medicare Secondary Payer Questionnaire (MSPQ) can lead to significant issues for a hospital, primarily because the MSPQ provides essential information regarding whether Medicare is the primary or secondary payer for a patient’s services. If this information is not included with the claim, it can result in improper claim processing.

Consequences of not attaching the MSPQ may include delays in payment, the claim being denied, or potential fines imposed on the hospital. The MSPQ helps ensure that the billing process is compliant with regulations and accurately reflects the patient's insurance status, preventing financial losses and maintaining the integrity of the claims process. Ultimately, adherence to these requirements safeguards the hospital against fines and administrative burdens associated with non-compliant billing practices.