Cahaba GBA’s 2014 Medicare Expo

1. Cahaba GBA’s 2014 Medicare Expo August 7, 2014 Chattanooga, TN Provider Contact Center (PCC) Presented by Renea Cloud Provider Outreach and Education As directed a copy of the presentation is available for viewing or download on the Cahaba GBA website

2. Disclaimer This resource is not a legal document. This presentation was prepared as a tool to assist our providers. This presentation was current at the time it was created. Although every reasonable effort has been made to assure accurate information, responsibility for correct claims submission lies with the provider of services. Reproduction of this material for profit is prohibited. 1

3. Agenda • Cahaba GBA Mission Statement • Provider Customer Service Program (PCSP) • Customer Service Representatives (CSRs) • Provider Inquiry • Provider Inquiry Calls • Inquiry Resolution Strategy 2

4. Cahaba GBA Mission Statement 3

5. Cahaba GBA Mission Statement Charting Our Course Our Mission: To provide best value solutions that improve healthcare administration http://www.cahabagba.com/ 4

6. Cahaba GBA Mission Statement Charting Our Course Our Values: • Integrity • Customer First • Teamwork • Innovation • Continuous Improvement 5

7. Provider Customer Service Program (PCSP) 6

8. PCSP Organizational Chart Part A Entitlement Customer Service Representatives Provider Contact Center Manager Part B Entitlement Provider Outreach & Education Manager Provider Outreach & Education Consultants Provider Services Departmental Manager Director of Operations Part A Entitlement Part B Entitlement Electric Data Interchange Manager Written Inquiry/Clerical Error Reopenings Manager http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/com109c06.pdf 7

9. Provider Customer Service Program (PCSP) Provider Contact Center • Centralized office for the purpose of receiving a large volume of requests by telephone to provide customer service and technical support to Medicare providers • Respond to inbound provider customer calls • Research and resolve a wide variety of customer questions and issues • Ensure information given is timely and accurate • Accurately and promptly document all calls Medicare Contractor Beneficiary and Provider Communications Manual 100-09 Chapter 6 – Provider Customer Service Program Section 30 – Provider Contact Center (PCC) http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/com109c06.pdf 8

10. Customer Service Representatives (CSRs) 9

11. Customer Service Representatives (CSRs) The Individual • Qualifications for CSRs: • Experience in Customer Service requiring problem solving • Ability to understand and interpret complex oral and written directions • Ability to multi-task • Experience research information 10

12. Customer Service Representatives (CSRs) CSR Training • Comprehensive Training Program: • Introduction to Medicare • Guideline Manuals • Fiscal Intermediary Standards System (FISS) • Multi-Carrier System (MCS) • Call Center Simulation • LIVE Call Center Observation • LIVE Call Center Log-in with Conference Supervision 11

13. Customer Service Representatives (CSRs) Continued Education http://www.cahabagba.com/contact-us/ 12

14. Provider Inquiry Calls 13

15. Provider Inquiry Calls Contacting Cahaba GBA • Contact Us: • Write • Email • Phone 14 http://www.cahabagba.com/contact-us/

16. Provider Inquiry Calls Telephone Inquiry Classification Process • Categories of Telephone Inquiry: • Interactive Voice Response (IVR) System • Level I – Customer Service Representative • Level II – Customer Service Representative • Escalated Provider Inquiry 15

17. Provider Inquiry Calls Interactive Voice Response (IVR) System • CMS Internet Only Manual (IOM) Chapter 6 Section 50.1: “Providers shall be required to use IVRs to access claim status and beneficiary eligibility information. CSRs shall refer providers back to the IVR if they have questions about claims status or eligibility that can be handled by the IVR. CSRs may provide claims status and/or eligibility information if it is clear that the provider cannot access the information through the IVR because the IVR is not functioning.” http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/com109c06.pdf 16

18. Provider Inquiry Calls IVR Mapping • Ability to view: • Prompt Entry • Prompt Option Completion 00000000000000 00000000000000 123456789 jsmiths 012345678 rsmiths 17

19. Provider Inquiry Calls Provider Contact Center Call Volume Part A Calls: • 23,158 Part B Calls: • 117,217 June Call Total: • 140,375 Daily Call Average: • 4679 18

20. Provider Inquiry Calls Level 1 – Customer Service Representative • Answer a wide range of basic questions that can not be answered by the IVR or other interactive self-service technology • Questions that do not require substantial research and answered during the initial call • If inquiry can not be answered, referral to second level CSR http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/com109c06.pdf 19

21. Provider Inquiry Calls Disclosure Desk Reference Guide • Authentication Requirements • Protected Health Information (PHI) disclosure guidelines http://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/Contractor-Resources.html 20

22. Provider Inquiry Calls Level II – Customer Service Representative • More complex inquiries requiring high levels of research • Allow 10 business days from initial call for review • If inquiry can not be answered, an escalated provider inquiry is submitted for review http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/com109c06.pdf 21

23. Provider Inquiry Calls Escalated Provider Inquiry • Complex provider inquiries only • Provider Relations Research Specialist • Complex inquiries regarding coverage policy, coding, and payment policies • Substantial research is required http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/com109c06.pdf 22

24. Provider Inquiry Calls June Top Phone Inquiry Stats 23

25. Inquiry Resolution Strategy 24

26. Inquiry Resolution Strategy Provider Call Research • Research Perimeters: • 5 Day Call Research/1.5 Hour Time Frame • Incoming Provider Calls (Part A & B) • Call Reason/Question • Caller Preparedness • Caller Etiquette • Call Resolution 25

27. Inquiry Resolution Strategy Research Analysis • Findings: • 83 Calls Received • 99 Separate Inquiries – Call Inquiry Rate of Return 119% 26

28. Inquiry Resolution Strategy Research Analysis 27

29. Inquiry Resolution Strategy Research Analysis 28

30. Inquiry Resolution Strategy Develop a Call Contact Plan • Provider Call Research showed: • 47% of callers unprepared at time of contact with CSR • Review of Unprepared Callers showed: • Missing required information to appropriately disclosure requested information • Did not have/know appropriate PTAN/NPI/Tax ID • Invalid Beneficiary Information • Invalid Information Entry into IVR • Denial Reason from Remittance Advise • Claim Validation Information • Reference ID Information • Check Numbers/Remittance Numbers 29

31. Inquiry Resolution Strategy Provide Inquiry Reason Hi, I am calling about…… • Claims Denial • Claims Status • Beneficiary Eligibility • Appeal Status • Provider Enrollment Question/Status • Revalidation Question/Status • Overpayment Recovery • Refund Status for Overpayment 30

32. Inquiry Resolution Strategy Provide Additional Information • Gather all essential information regarding your inquiry, be ready to provide additional information • NPI/PTAN/Tax Id • Reference Number(s) • Beneficiary Information • Claim Information • Remittance Advice Information 31

33. Inquiry Resolution Strategy Attain a Call Reference Number • A call reference number is the call segment identification information • Example: • GINQ • REVAL • FINSV • APPL 32

34. Inquiry Resolution Strategy Self Help Tools • Cahaba GBA Website provides multiple self-help tools to assist providers in their research • Claim Issue Log • Claim Submission Error (CSE) Log • Frequently Asked Questions (FAQs) • Check Status of Provider Enrollment & Revalidation Applications • Check Appeals Status • Check Eligibility & Claims Status https://www.cahabagba.com/ 33

35. Inquiry Resolution Strategy Self Help Tools • CMS Website provides multiple self-help tools to assist providers in their research • Internet Only Manuals (IOMs) • National Correct Coding Initiative Edits • Medicare Coverage Database • Latest ICD-10 Transition Information http://www.cms.gov/ 34

36. Cahaba GBA Website Kiosk 35

37. Cahaba GBA Website Kiosk Website Navigation Assistance • Live Onsite Assistance • Available Stations in Designated Area • Consultants Available to Assist with Website Navigation • Answer Questions Pertaining to Finding Medicare Information • ForeSee Survey http://www.cahabagba.com/ 36

38. Resources 37

39. Resources Cahaba Government Benefit Administrators • http://www.cahabagba.com/ Centers for Medicare and Medicaid Services • https://www.cms.gov/icd10/ Centers for Medicare and Medicaid Services Regulations & Guidance • http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html Medicare Coverage Database • http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx Washington Publishing Company • http://www.wpc-edi.com/reference/ 38

40. Question and Answer Session Q & A Provider Contact Center   1 (877) 567-7271 39

41. Thank you for joining us today! Please remember to complete your evaluation before departing, your feedback is valuable to us . 40