Medicare Compliance & Reimbursement

If the companies and agencies you utilize to do your Medicare billing aren’t using the Interactive Voice Response (IVR) system, it may be causing both claims and patient privacy issues.

Details: Part B Medicare Administrative Contractor (MAC) Palmetto GBA warns providers that it’s noticed an increase of IVR-related problems among billing companies and outsourced partners. “Some are failing and/or refusing to use the IVR or Palmetto GBA eServices,” the Part B MAC says. “Additionally, some of these individuals are not familiar with basic Medicare coverage or billing requirements and explanations and guidance must be repeated on every call.”

Plus, these outsourced businesses are tying up the phone lines with inane questions and rarely relate to the claims in question, Palmetto cautions. “The pattern we recognize most is questions that don’t pertain to the providers actual claim but instead are generic scripted questions that are asked over and over with the same exact response each time, and questions that can easily be answered by reviewing the Remittance Advice, using our Portal, the IVR and/or our website,” the MAC says.

Warning: Palmetto also urges providers to take their patients’ protected health information (PHI) into account when sharing data with the vendors and partners. The MAC reminds that the responsibility of protecting PHI lies with the healthcare provider not the billing company — and the provider is the one liable for any financial penalties for any impermissible disclosures.

Check out the alert at www.palmettogba.com/palmetto/jjb.nsf/ DIDC/AS4LHG6636~Medicare News.