CMS: How Does Your Contractor Rate?

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  • In CMS
  • January 5, 2009
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The Centers for Medicare & Medicaid Services (CMS) launched its fourth annual health care provider satisfaction survey. Approximately 30,000 providers nationwide were randomly selected to participate in the Medicare Contractor Provider Satisfaction Survey (MCPSS) where they’ll reflect on their experiences with federal payers. Selected participants were to receive an invitation by the first of the year.

“I urge all 30,000 Medicare providers selected to participate in the survey to complete and return their surveys upon receipt,” Acting CMS Administrator Kerry Weems said.
Medicare fee-for-service contractors process and pay more than $280 billion in Medicare claims each year. It’s time to tell CMS how these contractors are doing.
Survey questions focus on seven business functions that occur between provider and contractor:

  • Provider inquiries
  • Provider outreach and education
  • Claims processing
  • Appeals
  • Provider enrollment
  • Medical review
  • Provider audit and reimbursement

Will provider inquiries be at the top of the list in importance again this year? Only time and a good response rate will tell.

Certified Professional Coder-Payer CPC-P

No Responses to “CMS: How Does Your Contractor Rate?”

  1. Gail Platt says:

    Awful, since all the yorktown office was downsized, we cannot get anything done without spening hours on the phone, thanks

  2. Paual Blumenthal, CPC says:

    If I ran my office like they do I would have been fired. The amount of time needed to accomplish anything on the phone is a waste of valuable time to any office administrator. Every time we call we get a different answer. Whoever thought of using PIN numbers to help elevate the confusion of UPINS and other numbers were fooling themselves. Now have group PIN individual PIN and PtAN’S.
    It all appears to be one more way to hold up payment and to continue to confuse and frustrate the clerical staff of every medical office. It is a shame. AND this is all before ICD-10 is even impementhed. I can’t even imagine what we are in for in the future. Or better yet.. I can imagine. I can only hope I will be close to retirement.

  3. Tammy Baker, CPC says:

    I have nothing good to say about our new contractor NGS who took over upstate NY region last September. It takes at least 1 hour per phone call and we rarely have a solution or clear answer when we are done. We fought for 2 months to get them to correct a provider’s enrollment file that they entered wrong info on and couldn’t get them to return our phone calls. This caused a delay in billing for over 3 months. They consistently process claims wrong with erroneous denials and denials that directly contradict their own LCD’s. They held all our claims from the end of August due to internal conversion issues, then denied them in December for “lacking information” told us to rebill all of them and refuse to pay interest. If the federal government made the switch from Health Now to NGS to save money, they are wasting it. Their level one reps have no knowledge of claims or how they process and can do nothing to help except waste 15 minutes going thru it only to transfer you to a second level rep that requires at least 30 min on hold. If we ran our office with this level of knowledge and customer service we would be out of business. I wish we were one of the offices selected for this survey because I can’t find where to complain to about the poor service we are getting.

  4. Joyce Tessier, CPC, MCS-P says:

    I have nothing but KUDOS to Highmark on a smooth transition for NJ jurisdiction 12 from NGS as their former contractor. NGS had significant issues, lacking accurate knowledge in crucial areas, such as NPI subpart facts as they relate to provider enrollment, thorough and accurate provider enrollment application processing, adequate communication with provider offices on issues affecting their group reimbursement, etc. Immediately, the difference with Highmark is apparent. Their website is user-freindly and answers to questions are found almost immediately. Provider enrollment is effective, communicative and knowledgeable. Prompt and ongoing contractor efforts to educate in key areas was immediately available by way of live training sessions. The difference is huge and a welcome one!

  5. Liz Marcoux says:

    California was moved to Palmetto from NHIC in September 2008. What a nightmare it has been since! We spents “hours” on the phone on hold trying to get thru to a level 1 customer service rep. When we did get thru sometimes, we were given wrong information. Everytime we call in we get different answers, no one ever returns phone calls as promised. It is taking over 30 days to process claims and we are continually getting erroneous denials. Trying to get thru to their provider enrollment dept is near impossible. There does not seem to be a standard to which these contractors are held to. Since they have a contract, there is no incentive to provide a competent level of service. No wonder Medicare has the problems its does – look who it contracts with!

  6. Tammie Moss,CPC says:

    I am hoping that Noridian loses the contract. Appeals are a nightmare! The correct procedures are followed and redeterminations and appeals are denied stating the correct form or procedure was not filed. The proof has been attached to each claim. They had a glitch in their system with receiving modifiers inApril 2006. I was able to prove it through our clearing house that they were sent on our end and the clearinghouse end. Medicare did not receive them they stated. They processed the assist claims at 100% denied the surgeon claims as duplicate. At that time the reopening line for WA was inundated with calls and short staffed. I could never get through. I have sent the claims for redeterminations after new billings were sent and marked corrected. They recouped the assistant surgeon’s reimbursement and denied all claims for timely filing after they never replied to redeterminations and appeals. I sent these claims to the medical director in November and have not heard a response to date. Our contract was awarded to Highmark I believe and I am hoping that CMS denies Noridians appeal to keep our area.

  7. Marilyn Pratt CPC says:

    I also hope that Noridian loses the contract. We spend an obscene amount of time with COB issues and trying to get DME claims paid. Verifying eligibility with all the confused beneficiaries and the Medicare Advantage plans is also a mess. Busy signals are encountered at all times of day, every day of the week.

  8. Ann Manter says:

    January 22, 2009
    Big mistake on the hire of NGS for processing claims from Connecticut. Endless hours of telephone made concerning claims without results. Problematic claims – auto claims or liability claims are relentless. Once the file is MSP and there is no auto medical insurance available, it is almost impossible to get the claim paid. Each attempt is passed from different phone numbers, without response. Many of the Northeast regions have another contractor, I now know why.
    Paper claims for secondary claims with the appropriate documentation always worked before. Suggestion: Add specific telephone contacts – provider line-beneficiary line for claims that are pended for MSP. Attorneys handling cases for the claimants regarding MSP claims have made complaints, they can’t get results either. Lack of effort to resolve the problem is problematic. Training should be implemented immediately as there are many complaints of the same.

  9. Joanie says:

    And people think an answer to our healthcare problems are to let the government take it over.