CMS communicates information describing its billing requirements, as  well as other relevant regulations and policies, to physicians primarily  through its carriers. CMS and its carriers also sponsor a variety of  provider education activities, such as workshops and on-line training  courses, to help familiarize physicians with billing rules and other aspects  of the program and to update them on program changes. Carrier Communications Are Often Difficult to Use, Out of Date, Inaccurate, and Incomplete

Medicare information provided by carriers for physicians is often difficult  to interpret and use, out of date, inaccurate, and incomplete. Knowing the appropriate code for a medical  service is essential to properly billing Medicare. The lack of specific standards, sufficient technical assistance, and best  practice guidance creates an environment in which, as one CMS business  function expert said, each carrier must develop its own communication  strategies, resulting in duplication of carriers’ efforts and variations in the  quality of their service to physicians. It is working to  issue new Medicare rules and regulations on a more consistent and  predictable schedule, expand information resources available to  physicians, and obtain more physician feedback relating to Medicare  policies and communications. CMS is attempting to improve the consistency of information that carriers  provide to physicians and has both short-term and long-term projects  under way. For example, they are  developing a standard template for carrier bulletins. CMS is also addressing information that it provides directly to the  physician community. Because the majority of Medicare communications to physicians are  issued by carriers on behalf of CMS, we focused on the three main  methods these carriers use to communicate with physicians—carrier  bulletins, carrier provider assistance call centers, and carrier Web sites. Agency  officials also identified their current and planned efforts to improve its  process for communicating with Medicare providers.
What GAO Found

Unlike other federal programs that make expenditures under the direct control of the government, Medicare constitutes a promise to pay for covered medical services provided to its beneficiaries by about one million providers. Given this open-ended entitlement, it is essential that appropriate and effective rules and policies be specified so that only necessary services are provided and reimbursed. Congress and the Centers for Medicare and Medicaid Services (CMS) have promulgated an extensive body of statutes, regulations, policies, and procedures on what shall be paid for and under what circumstances. Information that carriers give to physicians is often difficult to use, out of date, inaccurate, and incomplete. Medicare bulletins that carriers use to communicate with physicians are often poorly organized and contain dense legal language. Similarly, other means of communicating with physicians, such as toll-free provider assistance lines and websites, have problems with accuracy and completeness. Although all carriers issue bulletins, operate call centers, and maintain websites, each carrier develops its own communications policies and strategies. This approach results in a duplication of effort as well as variations in the quality of carrier communications. CMS provides little technical assistance to help carriers develop effective communication strategies. Neither CMS carrier oversight nor self-monitoring by the carriers is comprehensive enough to provide sufficiently detailed information that could either pinpoint specific communication problems or identify poorly performing carriers. CMS is working to improve its physician communications by consolidating new instructions and regulations and issuing them on a more predictable schedule to lessen the burden of frequent policy changes that physicians cannot anticipate. CMS is also enhancing its education programs for both physicians and carrier staffs and expanding its efforts to obtain physician feedback. Finally, CMS is improving its national website and intends to develop a single web-based source of information for physicians.