September 28, 2001

Medicare Contractors Give Providers Inaccurate, Untimely Information

According to a study released Sept. 25 by the General Accounting Office (GAO), Medicare contractors frequently give providers inaccurate and outdated guidance regarding billing and payment policies. The report was released at a House Ways and Means Subcommittee on Health hearing regarding Medicare reform (see related article).

The study, Improvements Needed in Provider Communications and Contracting Procedures (GAO-01-1141T), evaluated the clarity, timeliness, and accuracy of contractors' responses to regulatory questions commonly asked by providers. The GAO found that only 15 percent of answers were complete and accurate. Nearly one-third were entirely incorrect.

The study also found that bulletins were frequently long and poorly organized, making it extremely difficult for physicians to identify relevant information. Web sites typically failed to comply with CMS content standards and lacked critical navigation tools such as search functions. In many cases, contractors did not provide sufficient advance notice of regulatory changes. Web site information was often outdated.

Based on their findings and an apparent need to improve contractors' communication with providers, the GAO recommended that CMS establish contractor performance standards, allow open competition for claims administration contracts, and provide quality incentives for outstanding service.

Information: Christiane Mitchell, AAMC Office of Governmental Relations, 202-828-0526.