Performance Data

The Centers for Medicare & Medicaid Services (CMS) administers and oversees the Provider Customer Service Program (PCSP) at the Medicare Administrative Contractors (MACs). CMS analyzes data to identify trends and make recommendations to improve the performance of the Medicare Fee-for-Service provider contact centers, the provider self-service technology options and to increase provider satisfaction.   

Key performance measures for the previous 3 months are available below so MACs can measure their performance against the national data. 

Provider Customer Service Program (PCSP): October 2020 – December 2020


Contact Center

Metric

October 2020

November 2020

December 2020

Average Speed of Answer (Seconds)

40.9

40.5

36.2

Average Talk Time (Minutes)

6.0

6.1

6.1

Completion Rate

99.0%

99.1%

99.0%

IVR Handle Rate

45.7%

44.8%

44.7%

IVR Transactions

1,406,793

1,179,157

1,200,922

Written Correspondence Received

26,310

23,761

24,716

Portal Transactions Received

18,721,575

17,304,695

18,582,160


Provider Outreach and Education (POE)

Metric

October 2020

November 2020

December 2020

POE Events

669

586

666

POE Events (Attendees)

26,962

48,136

32,386

Self-Paced Education (Occurrences)

1,746

1,758

1,828

Self-Paced Education (Clicks)

761,450

713,338

647,333


Quality

Metric

October 2020

November 2020

December 2020

Quality Assurance Monitoring (QAM)

96%

96%

97%

QCM (Privacy Act)

98%

98%

98%

QCM (Knowledge Skills)

97%

97%

97%

QCM (Customer Skills)

99%

99%

99%

QWCM (Privacy Act)

99%

99%

99%

QWCM (Knowledge Skills)

98%

98%

99%

QWCM (Customer Skills)

99%

99%

100%



Telecom Performance

Call Completions, CSR Answered Calls, and IVR Handled Calls charted for three months.

Monthly Completion Rates shown at bottom of graph - 99.1%, 97.7%, 98.9%

 

 

Provider Inquiries

Top 5 Telephone Inquiries by Subcategory: 
   October 2020 – December 2020

Claim Denials	Claim Overlap	91,929
Claim Status	Payment Explanation/Calculation	88,621
Claim Denials	Coding Errors/Modifiers	78,639
Claim Denials	Contractual Obligation Not Met	74,106
RTP/Unprocessable Claim	Contractual Obligation Not Met	67,012

Total CSR Telephone Inquiries: 1,348,430

 


Top 5 Written Inquiries by Subcategory:  October 2020 – December 2020

Appeals	Duplicates	26,114
RTP/Unprocessable Claim	Contractual Obligation Not Met	13,337
Appeals	Explanation/Resolution	10,593
Administrative Billing Issues	Filing/Billing Instructions	8,860
General Information	Incomplete Information Provided	8,840

Total Written Inquiries:  86,806

Each CSR call or written correspondence may cover one or more inquiries.

 

 

Provider Outreach and Education

Top 5 POE Events by Subtopic:  October 2020 – December 2020

Claim Submission/Billing Items/Issues	
New Medicare Card	
582
Payment Items/Issues	
Claim Related Data Analyses and Reports (MR denials, CSEs, inquiries, CERT denials, CBRs, PEPPER)	
317
Claim Submission/Billing Items/Issues	
Filing/Billing Instructions/Strategies - (i.e., Special Billing, Timely Filing)	
309
Self Service Tools	
WebPortal	
264
Policy/ Coverage Rules	
Benefits/Exclusions/Coverage Criteria/Rules 	
220

Total POE Events:  1,921

Each event may cover one or more subtopics.

 

Page Last Modified:
01/13/2021 11:16 AM