Medicare provider inquiries, enrollment, appeals draw mostly positive comments in survey

January 13, 2012

Most health care practitioners remain satisfied overall with Medicare payment contractors, according to the 2011 Medicare Contractor Provider Satisfaction Survey (MCPSS), conducted by Cambridge, Mass.-based Mathematica Policy Research for the U.S. Centers for Medicare & Medicaid Services (CMS).

However, the survey suggests Medicare should make it easier to resolve payment-related problems when they arise, enroll as a provider for the plan, and appeal Medicare payment decisions.

The CMS conducts the survey of Medicare fee-for-service (FFS) providers and suppliers – including hospitals, physicians, skilled nursing facilities, and laboratories – beginning in January each year to measure satisfaction with contractor performance, as required by the federal Medicare Prescription Drug, Improvement and Moderniza-tion Act of 2003 (MMA).

An executive summary of the 2011 survey, released last month, reports respondents gave Medicare payment contractors an average (arithmetic mean) score of 3.77 out of a maximum possible of 5.0.

Scores were highest for Regional Home Health Intermediaries (RHHIs) (3.77) and lowest for Part B Medicare Administrative Contractors (MACs) (3.56).

Nearly three-fourths (72 percent) of providers stated they were satisfied or very satisfied with their contractor’s overall performance. Approximately 13 percent stated they were dissatisfied or very dissatisfied.

Satisfaction scores changed little from the previous survey in 2010.

Overall satisfaction with Medicare fiscal intermediaries (FIs), carriers, and RHHIs exceeded 75 percent; in each case, dissatisfaction was about 10 percent. Satisfaction with Part A and Durable Medical Equipment (DME) MACs was nearly as high at 74 percent. Satisfaction with Part B MACs was somewhat lower at 69 percent and dissatisfaction was higher at about 15 percent.

Among business functions performed by Medicare payment contractors, the auditing and reimbursement, and claims processing elicited the highest rates of satisfaction, at 76 and 74 percent respectively. Lowest rates of satisfaction were expressed for provider enrollment (53 percent) and appeals (60 percent).

Respondents identified 13 elements of business-function performance as having special potential to increase provider satisfaction. Among the most commonly mentioned problem areas:

  • Ability to fully resolve problems without provider having to make multiple inquiries
  • Mechanisms offered for exchanging information about first-level appeals
  • After leaving a message, the average time before receiving a return call.

This year’s MCPSS data were collected between January and May of 2011. A sample of 31,452 Medicare providers was selected from all experienced Medicare providers served by the selected Medicare contractors. As in previous MCPSS administrations, an experienced provider was defined as one submitting 50 or more Medicare claims within the past 12 months.

The CMS plans to issue invitations to participate in the 2012 survey next month.

Optometrists should watch for the invitations in the mail and respond promptly if invited to participate.

Optometrists who receive a survey may also wish to touch base with their state optometry association to learn about issues, if any, that other optometrists are having with Medicare contractors.

The public report on the survey can be accessed online at www.cms.gov/MCPSS/downloads/MCPSS_Public_Report.pdf

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: