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): August 2019 – October 2019

Contact Center

Metric August 2019 September 2019 October 2019
Average Speed of Answer (Seconds) 52.3 57.6 43.7
Average Talk Time (Minutes) 5.7 5.7 5.6
Completion Rate 97.6% 96.9% 96.5%
IVR Handle Rate 50.4% 49.1% 48.9%
IVR Transactions 2,364,581 2,176,701 2,368,958
Written Correspondence Received 35,516 32,377 35,409
Portal Transactions Received 16,231,642 15,353,252 17,757,873

 

Provider Outreach and Education (POE)

Metrics August 2019 September 2019 October 2019
POE Events 708 763 942
POE Events (Attendees) 19,218 22,737 34,418
Self-Paced Education (Occurrences) 1,594 1,578 1,571
Self-Paced Education (Clicks) 604,073 619,759 725,880

 

Quality

Metric August 2019 September 2019 October 2019
Quality Assurance Monitoring 98% 96% 96%
QCM (Privacy Act) 98%

98%

98%

QCM (Knowledge Skills) 97%

96%

97%

QCM (Customer Skills) 100%

100%

99%

QWCM (Privacy Act) 99%

99%

99%

QWCM (Knowledge Skills) 98%

97%

98%

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: 
 August 2019 – October 2019

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: 1,839,746

 


Top 5 Written Inquiries by Subcategory: August 2019 – October 2019

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:  125,544

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

 

 

Provider Outreach and Education

Top 5 POE Events by Subtopic:  August 2019 – October 2019

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:  2,413

Each event may cover one or more subtopics.

 

Page Last Modified:
12/04/2019 06:25 PM