American College of Physicians: Internal Medicine — Doctors for Adults ®

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Complaints about your carrier? CMS wants to know

From the April ACP Observer, copyright © 2004 by the American College of Physicians.

By Brett Baker

Q: What is Medicare doing to improve the customer service that carriers provide to physicians?

A: The Centers for Medicare and Medicaid Services (CMS) is trying to seriously address physicians' complaints about the poor customer service they receive from Medicare carriers.

The CMS has asked ACP to submit member complaints about poor carrier service. The agency wants information pertaining to specific physician or staff interactions that physicians believe constitutes poor customer service.

Q: What type of information does the CMS want?

A: The CMS has requested the following information for each complaint:

  • carrier name;

  • Medicare unique physician identification number (UPIN);

  • date and approximate time of the call or interaction;

  • specific question asked or issue raised with carrier personnel; and

  • a description of the problem or complaint.

Q: Why is the agency looking for such specific information?

A: The CMS has known for a long time that physicians have had service problems with carriers. However, the agency wants to know about particular problems with individual carriers so it can take specific corrective actions.

Q: Do complaints I submit to the College have to contain identifying information?

A: The CMS has assured ACP that physicians who identify themselves through this complaint process will not be subject to investigation, nor will their names be kept on file by the CMS or the carrier.

However, ACP is encouraging members to submit complaints to the College, even if you're uncomfortable providing your UPIN. (The College will not submit the names of physicians who don't want to be identified.) ACP will compile all the complaints submitted, whether or not they contain a UPIN, and submit them to the CMS.

Please submit all complaints about Medicare carriers to Carol McKenzie, Administrative Coordinator in ACP's Regulatory and Insurer Affairs Department.

Q: What other changes has the CMS made to help improve carriers' service?

A: The CMS has begun to standardize the educational materials that carriers provide to physicians, including information regarding changes in coverage and reimbursement policies.

The CMS is now making sure that all educational texts for physicians are written by clinicians and medical coding or billing specialists. After July 1, carriers are required to use that standardized text in their bulletins, on their Web sites and in their call centers.

Q: Has Congress taken action to improve carrier service?

A: Under the new Medicare reform law, carriers will be required after Oct. 1, 2004, to provide responses that are "clear, concise, and accurate" to written inquiries within 45 days of receipt. (Carriers can reply electronically.)

Carriers must also maintain a toll-free phone number and an Internet site that physicians can use to get information on billing, coding, claims and coverage.

Brett Baker is a third-party specialist in the College's Washington office.

Corrections: The "New Medicare reform boosts pay for rural physicians" article in the March 2004 ACP Observer failed to provide an effective date for when carriers would begin automatically paying physicians health professional shortage area bonus payments. Those payments will begin Jan.1, 2005.

The article further implied that physicians could stop appending the modifier to the procedure code when billing for their services immediately upon enactment of the Medicare reform bill on Dec. 8, 2003. Physicians should continue to append the appropriate modifier to collect the 10% bonus payment until January 2005.

The article also incorrectly referred physicians to a "CMS zip code to carrier locality" file. This file is intended for use by ambulance suppliers. Physicians should continue to use notice of shortage area designations provided by their Medicare carrier.

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