Healthcare Business Management Association - HBMA
Leading the Business of Healthcare Login
Public News Public News - HBMA Healthcare Business Management Association

Medicare Contractors Get Failing Grade from GAO

Medicare Contractors Get Failing Grade from GAO

Date: 9/26/2001
News: GAO Gives Failing Grade to Medicare Contractors

In testimony before the House Ways and Means Health Subcommittee, the General Accounting Office (GAO) was highly critical of both the clarity and accuracy of the information being disseminated to providers by Medicare and it’s contractors.

Leslie Aronovitz, Director of GAO’s Health Care Program Administration and Integrity Issues Section testified September 25th that Carrier and Intermediary bulletins often contain, “long articles, written in dense language and printed in small type.” She also noted that many are very poorly organized and difficult for physicians to identify those topics relevant to their practice or specialty.

Aronovitz made particular note of instances where Carriers covering multiple states would circulate bulletin articles or policy announcements to all physicians within the Carriers service area that were only relevant to physicians within a portion of that jurisdiction. Unfortunately, it wasn’t until physicians were well into the article before it was noted that the policy was of only limited application. GAO also found instances of Carriers announcing policy changes in these bulletins after the effective dates for these policy changes.

Perhaps the most troubling testimony presented by Aronovitz had to do with the results of an anonymous test of the accuracy of the information being disseminated by the Medicare Carriers. According to Aronovitz, GAO staff placed 60 phone calls to the provider inquiry lines of 5 Carrier Call Centers. Three test questions were asked of the Center staff during these calls. Each of the questions was taken from the Frequently Asked Question (FAQ) section of the Carriers’ website. In other words, these were not trick questions but rather these were questions that had been asked enough that the Carriers had developed written policy and had it posted on their website.

Astonishingly, the GAO investigators got “complete and accurate” answers to the question only 15% of the time. In 53 percent of the cases, the answers provided by Carrier staff were incomplete and in 32 percent of the cases, the answer was entirely incorrect. Members of Congress, upon hearing the results of this test, were outraged. Tom Scully, Administrator of the Center for Medicare and Medicaid Services (CMS) had no ready answer for such a horrendous failure of this system. GAO’s findings served as rather dramatic of evidence supporting the complaints many billing companies have been making with regard to their interactions with Medicare Carriers.

GAO also investigated complaints from providers and billing companies about the volume of information being sent to them by Medicare and the Contractors. To assess the accuracy of these complaints, GAO contact 7 groups practices in different parts of the country. While the GAO investigators found that in fact these practices were being inundated with various documents on regulations and billing procedures, the vast majority of these documents were generated not by the government, but by consultants, medical societies or professional societies.
Aronovitz made the point that the government’s material, which accounted for about 10% of the information, was either so confusing or technical, that the consultants and societies needed to produce their information so the group practices could understand what it was that the government was trying to tell them. In other words, if the government had simply communicated clearly and effectively with the initial documents, the information from the specialty or professional societies would have been unnecessary.

Aronovitz’ testimony had originally been scheduled for September 11th. The following week, she was slated to appear at the HBMA Fall meeting where she planned to elaborate even further on GAO’s findings. Unfortunately, due to the terrorist events in New York and Virginia, the hearing and the Fall conference were both postponed

Aronovitz has expressed an interest in appearing before the HBMA membership when the Fall meeting gets rescheduled. She plans to not only go into greater depth with regard to her findings, but she would like to hear more about the individual experiences of HBMA members with regard to the clarity and accuracy of CMS information.

To view a copy of her testimony, go to the GAO’s website: And go to the section marked “reports”. Once there, click on “reports and testimony”. The title of the testimony is:
Medicare: Improvements Needed in Provider Communications and Contracting Procedures GAO-01-1141T, and it was released on September 25. The document is in PDF format and it is 12 pages long.

Source: Bill Finefrock Capitol Associates