Only 4 percent of the  responses we received from CSRs were correct and complete. Our test  suggested several factors that may account for poor performance,  including fragmented information scattered among a variety of sources,  confusing information that may be difficult for CSRs to understand and  interpret, and difficulties in retaining CSRs. CSRs Almost Never Provided Correct and Complete Responses to Our Policy Questions

We found that CSRs provided incorrect, partially correct, or incomplete  responses to 96 percent of the 300 policy-oriented test calls we made to  carrier call centers. Twelve of the references were  either incorrect or did not include all of the information needed to give a  correct and complete answer. CMS’s Efforts Not Targeted to Supplying Policy- Oriented Information to CSRs

Although CMS is currently implementing two initiatives that may improve  CSRs’ access to information, neither of these new tools is designed to  support the CSRs who respond to providers’ policy-oriented questions. Moreover, there are no plans to publish articles for the majority of existing  policies. Many of these centers triage  incoming calls through a feature known as “skill-based routing.” Skill- based routing systems are designed to enhance customer service by  allowing the call center to first identify the nature of an incoming call and  to then distribute the call to the CSR who is best qualified to respond to  the caller’s question. Call Center Oversight Does Not Adequately Assess CSRs’ Responses to Policy- Oriented Questions

CMS requires carriers to monitor the performance of their call centers. However, the performance standards that carriers are required to use, and  the technology available to most of them, do not facilitate thorough  assessments of whether CSRs provide correct and complete responses to  policy-oriented questions. In addition, CMS’s own monitoring efforts— CPEs and remote monitoring of select calls—do not provide sufficiently  detailed or meaningful information regarding CSR accuracy. In fiscal year 2002,  only one carrier call center had a CPE covering provider telephone  inquiries. Not one CPE was performed in fiscal year 2003. Now that CMS  has been given new authority to contract with a variety of entities to assist  it with managing the Medicare program, it should take the opportunity to  improve its communications with providers. Appendix I: Scope and Methodology

To determine carriers’ effectiveness in providing correct and complete  responses, we placed 300 calls to 34 carrier call centers. To determine the efforts CMS has made to provide oversight, we identified  CMS requirements for carrier call center operations and discussed with  CMS staff the agency’s oversight and monitoring of carrier call center  activities.
Why GAO Did This Study

In 2002, GAO reported that the Centers for Medicare & Medicaid Services (CMS) needed to improve its communications with providers who deliver medical care to beneficiaries. GAO reported that 85 percent of the responses it received to 61 calls made to call centers operated by Medicare carriers--contractors that help manage the Medicare program--were incorrect or incomplete. GAO also found that CMS's primary oversight tools were insufficient to ensure accuracy in communication. GAO was asked whether call centers now provide correct and complete information to providers. GAO (1) reviewed carriers' effectiveness in providing correct and complete responses to policy-oriented telephone inquiries and CMS's efforts to improve communications with providers and (2) evaluated CMS's efforts to provide oversight of carrier call centers.

What GAO Found

Only 4 percent of the responses GAO received in 300 test calls to 34 call centers were correct and complete. GAO posed four policy-oriented questions 75 times each to carrier call centers. The level of correct and complete responses for each individual billing question ranged from 1 to 5 percent. The majority of remaining responses were incorrect, or partially correct or incomplete. Several factors, including fragmented sources of information, confusing policy information, and difficulties in retaining the CSRs responding to calls appear to account for the lack of correct and complete answers. There are many call centers serving other industries that triage incoming calls by first identifying the nature of the call and then distributing it to the CSR who is best qualified to respond. Although CMS has not adopted this approach, it is currently implementing two other initiatives that may improve CSRs' access to information. However, neither initiative is specifically designed to support CSRs responding to policy-oriented questions. In addition, CMS's efforts to provide oversight of carrier call centers are inadequate. Although CMS requires carriers to monitor the performance of their call centers, the standards used and the technological resources available to evaluate performance do not allow carriers to thoroughly assess whether CSRs' responses are correct and complete. In addition, CMS's own monitoring efforts are too infrequent. CMS only performed one contractor performance evaluation related to carrier telephone services in fiscal year 2002 and none were performed in fiscal year 2003. Moreover, when performed, these evaluations did not provide sufficiently detailed information to assess CSRs' performance.