Making it easier to traverse the Medicare maze

June 1, 2005

As of January 1, the Centers for Medicare & Medicaid Services now require Medicare carriers to establish programs that better address questions from participants.

As of January 1, the Centers for Medicare & Medicaid Services now require Medicare carriers to establish programs that better address questions from participants. The new rules are the result of a 2003 Medicare reform bill passed by Congress to address complaints from program participants, who were having difficulty getting quick and accurate answers from carriers.

The rules specify that Medicare carriers must now have an automated voice response system on their telephone lines to answer the "easier" questions, according to American Medical News (2/7/05). The automated system would allow participants to find out the status of a claim, determine a patient's eligibility, or obtain definitions for codes.

Medicare carriers must also implement a triage system, which would direct more complex inquiries to staffers who have received advanced training in the program's policies. These staffers could address issues involving Medicare coverage, coding, and payment.

Physician practices with fewer than 25 full-time employees can also take heart. Medicare carriers must now hold "Ask the Contractor" teleconferences. These conferences, to be held quarterly, will share program information and allow participants to provide feedback.