Part B Insider (Multispecialty) Coding Alert

Published on Sun Dec 12, 2004 PDF

And providers aren't too clear on Medicare laws either

Medicare's call line needs a  lifeline.

Calls to the 1-800-MEDICARE help line only yielded accurate answers 61 percent of the time in a recent test. The phone operators provided wrong answers 29 percent of the time and no answer 10 percent of the time, according to a report by the Government Accountability Office, "Accuracy of Responses from the 1-800-MEDICARE Help Line Should Be Improved" (GAO-05-130).

The GAO asked six questions 70 times each, and checked the call center reps' answers against the model answers provided by the Centers for Medicare & Medicaid Services. The topics of the questions included drug cards, Medigap, power wheelchairs, Medicare Part B enrollment and eye exams.

"Centers for Medicare and Medicaid Services' trained counselors cannot provide useful  information to millions of people confused by the new Medicare law," warned Robert Hayes, president of the Medicare Rights Center, in a statement. The drug benefit slated to begin in January 2006 will be even more confusing for older and disabled Americans." He encouraged Congress to simplify the benefit.

"In recent years, Medicare providers have become increasingly concerned about the quality of guidance issued by CMS," laments the GAO in another report.

The Department of Health and Human Services has two different mechanisms for issuing advisory opinions about Medicare law, but neither process encompasses the whole variety of regulations and laws governing Medicare, the GAO insisted in "Advisory Opinions As A Means Of Clarifying Program Requirements" (GAO-05-129). The Medicare Modernization Act instructed the GAO to study the possibility of HHS instituting an advisory opinion process for Medicare regs.

The GAO found that a few factors were crucial to successful  advisory opinions: defining the scope of the opinion process,   having alternative methods of responding to requests that don't need a new opinion, having a time frame for responding to requests, having enough staff to respond to requests, and having internal review and coordination with other agencies that might be affected by an opinion.