Doctors to rate Medicare contractors

An annual CMS survey gives physicians and others the chance to grade contractors on several business functions.

By Chris Silva — Posted Jan. 18, 2010

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The Centers for Medicare & Medicaid Services wants to hear from physicians and other health care professionals about their experiences with Medicare contractors.

CMS is sending the fifth annual Medicare Contractor Provider Satisfaction Survey to roughly 30,000 randomly selected program participants nationwide, including physicians, suppliers and institutional facilities.

Survey questions focus on seven key business functions of the doctor-contractor relationship: provider inquiries; education and outreach; claims processing; appeals; enrollment; medical review; and audit and reimbursement.

CMS asks respondents to choose a level of satisfaction on a six-point scale. One example from the 2010 survey is: "In the past 12 months, how satisfied have you been with the professionalism and courtesy of your contractor's representatives during the provider enrollment process?"

Physician advocacy groups said they are pleased to have the opportunity once again to offer feedback to CMS on fee-for-service processes.

"It's good for CMS to look inward and do this," said Anders Gilberg, vice president of public and private economic affairs for the Medical Group Management Assn. "Where the Medicare program deviates from the private sector is the processes that are unique to the program, such as enrollment and certification."

Gilberg said Medicare usually does well on satisfaction surveys in areas such as administration services and appeals but that MGMA members frequently raise concerns about enrollment and certification.

The annual survey started after the Medicare Prescription Drug, Improvement and Modernization Act of 2003 mandated that CMS develop contract performance requirements, including measuring satisfaction with Medicare contractors.

CMS said the effort allows the agency "to hear provider concerns, monitor trends, improve contractor oversight and increase efficiency of the Medicare program." It also uses survey findings as a benchmark to monitor future trends, as well as to improve its oversight and increase the efficiency of Medicare.

Contractors that CMS asked physicians to grade in 2009 included Highmark, Palmetto GBA, TrailBlazer Health Enterprises and Cahaba GBA. Some firms have come under fire in recent years for what physicians said were botched transfers of enrollment information from the old carrier system to the new contractor system, leading to payment delays.

CMS said participation in the survey is simple and confidential, and selected physicians can access it online. The agency plans to analyze the 2010 data and release a summary report on its Web site this summer.

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How contractors rated in 2009

The Medicare Contractor Provider Satisfaction Survey questions used a rating scale of 1 to 6, with 1 representing "not at all satisfied" and 6 representing "completely satisfied." CMS found there were not marked changes in the average survey scores from those in 2008.

  • 81% of physicians and other Medicare participants scored their contractors between 4 and 6 on the overall satisfaction question.
  • 81% wanted more training and education about claims processing.
  • 77% wanted more training and education on appeals and payment policy functions.
  • On average, contractors' claims processing business function received the highest scores, while their appeals function received the lowest.

Source: "Medicare Contractor Provider Satisfaction Survey -- 2009 Administration," Centers for Medicare & Medicaid Services, November 2009 (link)

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