PPAC Criticizes Medicare Coding Communication

By Frieden, Joyce | Clinical Psychiatry News, January 2004 | Go to article overview

PPAC Criticizes Medicare Coding Communication


Frieden, Joyce, Clinical Psychiatry News


WASHINGTON -- Wondering whom to call about a Medicare coding issue? Don't bother trying your local Medicare carrier, several physicians said at a meeting of the Practicing Physicians Advisory Council.

In the Kansas region, the Medicare carrier has virtually eliminated its service for answering provider questions, said Practicing Physicians Advisory Council (PPAC) member Dr. Rebecca Gaughan, an otolaryngologist in Olathe, Kan. "Even if you get an accurate response, no one's standing by it, and the physician is responsible."

Gerry Nicholson, director of the provider communications group at the Centers for Medicare and Medicaid Services, acknowledged that carriers are doing a poor job helping providers figure out how to code correctly. "Coding is something we talk about a lot," she said. "I understand your needs and problems, but I'm not sure of the answer."

In her testimony to the council, Ms. Nicholson mentioned a February 2002 survey of Medicare's physician communication efforts conducted by the U.S. General Accounting Office (GAO). The survey--whose results Ms. Nicholson did not discuss--found that customer service representatives answered only 15% of test calls "accurately and completely," and that only 20% of carrier Web sites contained all the information required by the agency. (For more information on the survey, go to www.gao.gov and search for report number GAO-02-249.)

But getting accurate answers is only part of the problem, Dr. Gaughan said. "What I want is to be able to call on a coding question, have my office be told, "This is the rule; we guarantee it; it was Julie I talked to at 3:20 p.m.' That way, when the Office of Inspector General comes knocking on my door, then I have proof."

PPAC member Dr. Douglas Wood, a Rochester, Minn., cardiologist, brought up another issue. "You have a patient who asks you, 'Is this [service] covered by Medicare?' and the answer sometimes is, 'I don't know,'" Dr. Wood said. "The patient can't call [Medicare to ask], because there's no advance determination of coverage. …

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