GAO says MDs still get misinformation from Medicare

November 1, 2004

Physicians with questions concerning Medicare billing aren't likely to get the right answers from those who staff Medicare carrier phone banks, according to a study by the Government Accountability Office. The study found that customer service representatives at the phone banks provided accurate and complete responses to billing questions only 4% of the time, and gave incorrect answers 54% of the time.

Physicians with questions concerning Medicare billing aren't likely to get the right answers from those who staff Medicare carrier phone banks, according to a study by the Government Accountability Office. The study found that customer service representatives at the phone banks provided accurate and complete responses to billing questions only 4% of the time, and gave incorrect answers 54% of the time.

This GAO study is a follow-up to a study performed nearly 2 years ago. Back then, the phone banks' staff answered billing questions correctly 15% of the time.

For the latest study, the GAO made 300 calls to Medicare carrier call centers. The questions it posed dealt with how to bill the program appropriately in the four situations: when a patient is transferred from one hospital to another; for services given by therapy students; for multiple surgeries performed on a single patient on the same day; and for an office visit and procedure for the same patient on the same day.

In response to the report, officials at the Centers for Medicare & Medicaid said they planned to create a system in which billing policy questions "are automatically routed to supervisors or other more experienced call takers who are more likely to be able to answer (questions) correctly." The agency will also complete the development of comprehensive and searchable documentation to make it easier for call takers to access reference materials, and will increase monitoring requirements for call centers.