Medicare's no-help line: Doctors not getting good answers

A report saying Medicare carrier call centers rarely give the correct answer to billing questions highlights the need for Congress to protect physicians from overzealous fraud investigators.

Editorial. Oct. 4, 2004.

For years, the AMA has called on Congress to halt abusive enforcement practices by the federal government and refocus its investigations to traditional definitions of fraud rather than inadvertent billing errors. Although the Centers for Medicare & Medicaid Services has assured physicians that their confusion over billing is not a major target for Medicare fraud investigations, honest mistakes are still actionable under the False Claims Act and subject to a civil monetary penalty.

So when it's time for physicians to bill Medicare, it would make sense to clear up any confusion by contacting Medicare call centers to ask for advice, lest a miscoded claim be construed as fraud. Except that, according to a Government Accountability Office study, physicians have only a 4% chance of getting a correct and complete response to their question.

That means 96% of time -- as happened when the GAO ran 300 test calls posing four questions on Medicare billing -- customer service representatives gave answers that were incomplete, only partially correct or completely wrong. That last category -- completely wrong -- made up half of those botched answers, according to the GAO.

Not that this is a new problem. A similar survey two years ago put the correct-answer rate at 15%, which looks downright reliable compared with the current 4%. No wonder AMA Board of Trustees Chair J. James Rohack, MD, responded to the news by saying, "While the Medicare call centers' inability to correctly answer physicians' questions is troubling, sadly, it is not surprising."