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

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

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

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

9. 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 Provider Contact Center Provider Customer Service Program (PCSP) 8 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

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11. 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 The Individual Customer Service Representatives (CSRs) 10

12. 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 CSR Training Customer Service Representatives (CSRs) 11

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

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

16. Categories of Telephone Inquiry: 1.Interactive Voice Response (IVR) System 2.Level I – Customer Service Representative 3.Level II – Customer Service Representative 4.Escalated Provider Inquiry Telephone Inquiry Classification Process Provider Inquiry Calls 15

17. 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.” Interactive Voice Response (IVR) System Provider Inquiry Calls 16 http://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Downloads/com109c06.pdf

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

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

20. 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 Level 1 – Customer Service Representative Provider Inquiry Calls 19 http://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Downloads/com109c06.pdf

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

22. 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 Level II – Customer Service Representative Provider Inquiry Calls 21 http://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/Downloads/com109c06.pdf

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

24. June Top Phone Inquiry Stats Provider Inquiry Calls 23

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26. 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 Provider Call Research Inquiry Resolution Strategy 25

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

28. Research Analysis Inquiry Resolution Strategy 27

29. Research Analysis Inquiry Resolution Strategy 28

30. 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 Develop a Call Contact Plan Inquiry Resolution Strategy 29

31. 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 Provide Inquiry Reason Inquiry Resolution Strategy 30

32. 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 Provide Additional Information Inquiry Resolution Strategy 31

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

34. 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 Self Help Tools Inquiry Resolution Strategy 33 https://www.cahabagba.com/

35. 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 Self Help Tools Inquiry Resolution Strategy 34 http://www.cms.gov/

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37. Website Navigation Assistance Cahaba GBA Website Kiosk 36 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/

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39. Resources 38 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 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/

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

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