Study: Medicare call centers fumble policy questions

Medicare call centers lack the resources to provide accurate policy information to health care providers, according to a recent study by the Government Accountability Office.

'During our test calls, customer service representatives typically provided incorrect and incomplete answers to the 300 policy-oriented questions we posed,' GAO reported. 'Only 4 percent of their responses were correct and complete.'

The Centers for Medicare and Medicaid Services are deploying two applications to improve call center performance, but neither addresses the issue of accurate policy information.

A Next Generation Desktop for service reps is being deployed to provide a single source of Medicare claims information, but it will not provide information on policy. A new remote monitoring system could improve CMS oversight of call center performance, but currently is understaffed and lacks the ability to monitor computer activity.

The report, Medicare: Call Centers Need to Improve Responses to Policy-Oriented Questions from Providers, recommends that CMS develop a system to screen calls and route them to staff with the best expertise, develop an electronically searchable source of clear information, and improve its call monitoring program.

Contractors that process Part B Medicare claims from physicians operate 34 call centers, which received more than 21 million calls from providers in 2003. Most were questions about the status of claims, and an Interactive Voice Response system answered about half of those without the help of a customer service representative. But an estimated 500,000 questions were about Medicare policy, which sent reps searching for data.

GAO found there was no single source of accurate data on Medicare policy.

'CSRs rely on fragments of information from multiple electronic sources,' including Web sites operated by the contractors and CMS, GAO said. They also rely heavily on printed material. 'Although CMS required that all CSRs have access to the Internet in fiscal 2003, some CSRs continue to rely heavily on paper documents because of their familiarity with these materials.'

CMS said it has an online manual of policy and billing instructions at, and is developing customized Web pages for physicians, hospitals and other providers.

'Unlike the GAO recommendations, however, CMS envisions a staff other than the CSRs as the primary user.'

CMS also will require that contractors use a tiered approach to answering provider questions, taking advantage of representatives' areas of expertise.

About the Author

William Jackson is a Maryland-based freelance writer.


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