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MCPSS, CAHPS and IACS-PC: Important news for health care professionals
Physicians and office staff should be aware of two Medicare quality initiatives and the release of software for CMS Internet applications.
 William D. Rogers |
Nobody is more turned off by acronyms than I am, but the three programs referred to in the headline of this article are Medicare initiatives that are important, good news for physicians. The first two acronyms refer to Medicare quality initiatives that you might not know about. The third acronym refers to the release of software that will allow you to access CMS Internet applications. If you are frustrated with your carrier, with Medicare Part D and with the paper-based physician enrollment program, read on.
MCPSS
The Medicare Contractor Provider Satisfaction Survey (MCPSS) was created to comply with a mandate in the Medicare Modernization Act of 2003. Congress directed Medicare to develop a program to assess physicians’ opinions concerning their carriers. In 2006, the first survey was conducted; 25,000 physicians and other health care providers were asked questions concerning claims processing, appeals, enrollment, medical review, audit, carrier outreach and technical assistance to physicians.
The study was repeated in 2007, as it will be every year. In 2007, 35,000 randomly selected physicians and other providers were surveyed. The study consisted of 67 questions and took about 20 minutes to complete. More than 65% of those who were sent a study completed it, which is an indication of just how important doctors think it is to give Medicare feedback on the carriers.
You can read the entire study at www.cms.hhs.gov/MCPSS/downloads/MCPSS_Report.pdf. Carriers scored from a low of 4.12 for Noridian Administrative Services to a high of 4.66 for Blue Cross Blue Shield of Kansas. Labs tended to give carriers higher scores, while physicians tended to be more critical. Carriers had pretty high satisfaction scores for their ability to process claims; not surprisingly, their processing of appeals caused the most heartburn.
These customer satisfaction scores are important to CMS. As we transition to Medicare Administrative Contractors, we are requiring that the contractors keep their satisfaction scores within a narrow range. In addition, the Medicare Administrative Contractors award fee will be affected by the MCPSS score. Better scores mean more money. Participants in the study are randomly selected, so you might well be asked to participate this year or next. If you are asked, please fill out the survey and send it back to CMS. Without this information, it is going to be much harder to hold carriers accountable for the quality of their service to you.
CAHPS
Part D plans are another source of frustration for physicians. As we know well from handling your complaints, some plans are much more physician friendly than others. The Part D plans now have their own Medicare survey to contend with. Unfortunately, we are not yet surveying physicians directly, but we have developed a survey that is administered to the Medicare beneficiaries. I believe that if patients are frustrated with their Part D plan, then the doctors probably are, too. Patients and doctors have the same issues — restrictive formularies, slow appeals processing and quantity limits — and therefore patient satisfaction is probably a pretty good surrogate for physician satisfaction.
The Part D survey is called the Consumer Assessment of Healthcare Providers and Systems (CAHPS). The results of this survey are used by CMS to rate the plans, and the ratings are one factor that Medicare beneficiaries consider when they decide which plan to enroll in. Plans that make the beneficiary happy attract more customers. Plans with restrictive formularies and cumbersome administrative policies attract fewer. There is something appealing about that model.
IACS-PC
Doctors will need to establish an Individuals Authorized Access to CMS Computer Services-Provider Community (IACS-PC) account before you can access to CMS applications such as the upcoming online provider enrollment system. Because registering in IACS can take time, I suggest that a physician who is planning to enroll or make a change in their enrollment and who wants to have online access to their Medicare provider enrollment information should do the preliminary registration in IACS now. Before that, I suggest you read the series of MLN Matters articles to understand the process. These may be found on the CMS Web site:
www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf
www.cms.hhs.gov/MLNMattersArticles/downloads/SE0753.pdf
www.cms.hhs.gov/MLNMattersArticles/downloads/SE0754.pdf
It seems reasonable to make sure that CMS data is only accessed by those who should have access, and I think you will agree. The benefits of being able to submit enrollment applications, perform revalidation and update your profile online will justify the investment of an hour working through IACS-PC. We hear a lot from frustrated physicians who have had trouble with the current paper-based enrollment process, and we are excited that this project is so close to fruition.
NPI
Hopefully you are now including your National Provider Identifier (NPI) on all your claims. A good number of your colleagues are not using their NPI, and as a result, as of March 1, all claims submitted without an NPI are going to be returned to the doctor unpaid. Recent CMS data showed that almost 10% of claims still do not include an NPI. Ask your office manager today if you are successfully billing with your NPI. If not, call your contractor now.
If you already bill using the NPI/legacy pair in the primary fields and your claims are processing correctly, now is a good time to submit to your contractor a small number of claims containing only the NPI. If these go through, increase the volume. This testing will serve to assure your claims will successfully process when only the NPI alone is mandated on all electronic transactions beginning May 23.
For more information:
William D. Rogers, MD, FACEP, director of the Centers for Medicare and Medicaid Services physician’s regulatory issues team, can be reached at the Office of the Administrator, CMS/HHS, Room 314-G, 200 Independence Ave. SW, Washington, D.C. 20201; 202-690-5907; e-mail: william.rogers@cms.hhs.gov.