Part B Insider (Multispecialty) Coding Alert

Published on Fri May 23, 2003 PDF

The next time you call your carrier, you may be on hold for a little less time.

The Centers for Medicare & Medicaid Services has issued a Medicare Carriers Manual update instructing carriers to start keeping track of the amount of time people spend on hold, how many people abandon a call before they get to speak with someone, and how many issues the carriers can resolve in one call. It's all part of a new customer-service emphasis at the carriers, at least if CMS gets its way.

CMS reminds carriers that they're supposed to respond to inquiries within 45 calendar days. In instances when they can't respond that quickly, they should send an "interim response" acknowledging the inquiry and explaining the delay.

The new instructions, in Transmittal 148, spell out the minimum standards of computers the carrier reps should have, the font and other readability standards their written responses should live up to, and other nitpicky areas that CMS hopes will make the carriers more customer-friendly. Carrier reps should develop a "report of contact" for each caller, including all of the caller's information and the name of the customer-service rep who tackled the inquiry.

The carriers must develop a "written plan to strengthen the quality" of their written responses to providers, CMS instructs. This plan should include an internal review process and activities that ensure constant improvement in the quality of carrier communications.

If need be, DMERC reps must involve clinicians in responding to coverage and coding inquiries from providers and use clinicians to score the accuracy of their responses to such inquiries.

Live telephone service must be available constantly during normal business hours, including break and lunchtimes. If customers have to wait before talking to a rep, a recorded message should advise them of the delay and make sure they have certain information ready before speaking to the agent.

Outside of normal business hours, interactive voice response units should provide callers with an after-hours message letting them know when to call. Carriers should staff call centers based on the pattern of call volume.