Opinion

Medicare management chief: Nearly all caller queries answered correctly

LETTER — Posted Nov. 22, 2004

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Regarding "Medicare's no-help line: Doctors not getting good answers" (Editorial, Oct. 4): Your editorial about the Medicare call centers misrepresents the recent study by the Government Accountability Office. Medicare carriers answer 29.6 million calls annually, and we estimate that less than 5% of those calls are of the type studied by the GAO.

We agree that all complex policy questions need to be answered, but the issue needs to be put in context. Your editorial tells physicians they have "only a 4% chance of getting a correct and complete response to their question" when more than 95% of all calls are about specific claims and are answered correctly every day.

That said, the Centers for Medicare & Medicaid Services takes all of these calls quite seriously and is working to dramatically improve the accuracy of all the calls it receives, including those calls surveyed by the GAO.

As stated in our response to the report, we are establishing a triage process so that these calls are routed to carrier staff with the right level of expertise.

We are also improving the accuracy of our educational materials for providers and customer service representatives and, at the same time, increasing training for the customer service representatives. Our efforts will continue until we have the confidence of physicians and their billing staffs that the answers they get from the Medicare call centers are ones on which they can rely.

Herb Kuhn, director, Center for Medicare Management, Centers for Medicare & Medicaid Services

Editor's note: Our editorial referred to "questions on Medicare billing," meaning the policy-related questions studied by the GAO, and explored in detail in our Sept. 6 news coverage of the report, "Have a Medicare policy question? Carriers usually give wrong answers." As noted in the letter above, most of the 29.6 million calls cited are about specific claims. They relate to matters such as eligibility, claim status and claims adjustment. To whatever extent our editorial was unclear, we apologize to our readers and to those individuals who correctly answer those calls.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/11/22/edlt1122.htm.

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