Hey, Tell Us Something We Didn't Already Know

In July the Government Accountability Office (GAO) published a report titled “Medicare Call Centers Need to Improve Responses to Policy Oriented Questions From Providers.” This report, directed to Rep. Pete Stark, the ranking minority member of the House Ways and Means Subcommittee on Health, confirms what staff of the APA's Office of Healthcare Systems and Financing (OHSF) and many APA members already know: it's very likely you'll get an incorrect answer if you call your Medicare carrier's call center asking for help with a policy question rather than just for a status report on a claim.

The GAO posed questions “concerning the proper way to bill Medicare in order to obtain payment from the program” and concluded that only 4 percent of the responses they received to 300 policy-oriented test calls were correct and complete.

In the report the GAO noted, “Because of the complexity of the program and the high volume of claims submitted annually. .it is critical that physicians and other providers who bill Medicare have access to clear and comprehensive information about the program.”

This report was done as a follow-up to a report the GAO (then the General Accounting Office) had developed in 2002 based on a smaller number of phone calls requesting information. That report found that answers were incorrect or incomplete 85 percent of the time and made suggestions to improve the rate.

As a result the GAO made these recommendations to CMS:

The report is posted at the GAO Web site at<www.gao.gov/new.items/d04669.pdf>.

If you have posed a question to your Medicare carrier and are concerned you have not received correct information, contact Ellen Jaffe through the Managed Care Help Line at (800) 343-4671 or via e-mail at [email protected]. OHSF recommends that you always ask for the name of the customer service representative who assists you when you call your Medicare carrier and that you document what you've been told. ▪