Medicare carriers to answer faster, better

New CMS rules require contractors to have automated voice response for simple queries and a triage system for tougher ones.

By David Glendinning, AMNews staff. Feb. 7, 2005.

Washington -- Physicians who feel that federal officials are too focused on how accurately doctors bill Medicare may be gratified to learn that the government has started taking a closer look at how well its contractors are helping in this process.

As of Jan. 1, Medicare carriers must have in place a "provider customer service program" designed to give the best answers to the myriad types of physician queries that come their way. Congress included the mandate in its 2003 Medicare reform measure after the American Medical Association and other groups complained that program participants too often were having a tough time getting quick, accurate information from contractors.

The first step in solving this problem lies in taking care of the easier questions without involving too much effort from either party, the Centers for Medicare & Medicaid Services states in a September 2004 instruction manual explaining the new requirements. Carriers now must have an automated voice response system set up on their telephone lines that allows physicians to check on the status of a claim, determine eligibility for a patient or obtain definitions for certain types of codes.

For the harder issues, carriers must establish a triage system that quickly routes inquiries to staffers who will be able to give an accurate answer. The more complex questions about Medicare coverage, coding and payment will be directed to specialists who have advanced training in program policy.