Psychiatric News September 17, 2004
Volume 39 Number 18
© 2004 American Psychiatric Association
p. 13
Psychiatric Practice & Managed Care
|
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:
- Create a process to screen calls and route questions to staff with
appropriate expertise.
- Develop policy-oriented material that is easily available to customer
service representatives.
- Establish an effective monitoring program for call centers.
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
ejaffe{at}psych.org.
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. 
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