Elisa Elderbaum

IT Business Advisor National Government Services,

formerly Empire Medicare Services

Collecting, Managing, & Analyzing User Feedback

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AgendaAgenda

• Introduction - National Government Services• Reports

– Compliance Reports– Operations Reports– Continuous Improvement

• Lessons Learned• Future Improvements

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National Government Services

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National Government ServicesNational Government Services

• Serves over 22.5 million people with Medicare Serves over 22.5 million people with Medicare in 26 statesin 26 states

• In 2006, responded to 10.4 millions calls In 2006, responded to 10.4 millions calls • Processed over 208 million Medicare claims Processed over 208 million Medicare claims

and administered benefits of more than $87.9 and administered benefits of more than $87.9 billionbillion

• Currently at 240 portsCurrently at 240 ports• Contact center locations:Contact center locations:

– Syracuse, NYSyracuse, NY– Bohemia, NYBohemia, NY– Harrisburg, PAHarrisburg, PA– Milwaukee, WIMilwaukee, WI– Indianapolis, INIndianapolis, IN– Manchester, NHManchester, NH– Cincinnati, OHCincinnati, OH

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Medicare Insurance Programs

• Part A – Medicare Hospital Insurance (Hospitals)

• Part B – Medicare Supplementary Medical Insurance (Doctor’s Offices)

• Part C – Medicare HMO Program

• Part D – Medicare Prescription Drug Benefit

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Self-Service OptionsSelf-Service Options

Medicare Part AMedicare Part A• Patient Eligibility• Claims Status• Financial Information (Check

Remittance)• Commonly Requested

Telephone Numbers• Commonly Requested

Addresses• Commonly Requested Websites• Hours of Operation• Seminar Information• HMO Information• Appeal Rights

Medicare Part BMedicare Part B• Patient Eligibility• Claims Status• Patient Deductible Status• Procedure Code Pricing• Seminar Schedules• Earnings• Commonly Requested

Telephone Numbers• Commonly Requested

Addresses• Fax-On-Demand

Information• Appeal Rights

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Reports

• Compliance Reports

• Operations Reports

• Continuous Improvement

• Dashboard

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Compliance Reports

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Compliance ReportsCompliance Reports

• The Centers for Medicare and Medicaid Services (CMS) have established Service Level Agreements that contractors must meet

• National Government Services submits these weekly reports externally to CMS to remain in compliance

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Compliance ReportsCompliance Reports

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Operations Reports

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Operations ReportsOperations Reports

• Reports used internally for day-to-day Reports used internally for day-to-day maintenance of the systemsmaintenance of the systems

– IVR Port UtilizationIVR Port Utilization– Application Failure ReportApplication Failure Report– Host Transaction Failure ReportHost Transaction Failure Report

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IVR Port UtilizationIVR Port Utilization

Daily IVR Port Utilization Report Period: 07/01/07 – 07/07/07

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Port Utilization TrendsPort Utilization Trends

IVR Port Utilization 2007 YTD

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Backend Transaction FailuresBackend Transaction Failures

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Continuous Improvement

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Continuous ImprovementContinuous Improvement

• Reports are generated daily, weekly and Reports are generated daily, weekly and monthly for to track IVR activitymonthly for to track IVR activity

• Augments automation by identifying areas for Augments automation by identifying areas for improvement critical to the success of improvement critical to the success of automationautomation

• Reports are used internally to identify Reports are used internally to identify improvement areas improvement areas

• Reports are also used externally as a Reports are also used externally as a continuous education processcontinuous education process

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Completed Transaction Summary

Transaction Count

Play Eligibility Information 3,641

Play Claim Information 391

Play Claim Details 229

Play Last 3 Checks Information 116

Play HMO Information 24

Others 64

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Failed Transaction Summary

Transaction Count

Medicare Number Not Found 4,814

Caller Exceeded Maximum Retry Attempts

279

Incorrect Patient Date of Birth 249

Caller Requested Operator 186

Caller Exceeded Response Timeout

122

Others 216

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Failed Transactions by ProviderFailed Transactions by Provider

X5 X1

X2X3

X4

X1 X2 X3 X4

X5

Failed Transactions by Provider

ProviderTransaction Failures

X1 23

X2 13

X3 13

X4 11

X5 10

TOTAL 445

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Lessons Learned

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Lessons LearnedLessons Learned

• Improvement is a continuous processImprovement is a continuous process• Empower your live agentsEmpower your live agents

– Teach them the automated system so they can teach your Teach them the automated system so they can teach your callerscallers

• Listen to your callers; factor in their wants & needs into Listen to your callers; factor in their wants & needs into your improvement plansyour improvement plans

• Treat automated “agents” like live agentsTreat automated “agents” like live agents– Train and refine the automated “agent”Train and refine the automated “agent”

• Use IVR system reports to help guide the improvement Use IVR system reports to help guide the improvement processprocess

• Technology can only take you so farTechnology can only take you so far• Analyze the data – don’t wait until the end of the Analyze the data – don’t wait until the end of the

project. Understand what it meansproject. Understand what it means

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Future Improvement

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Future ImprovementFuture Improvement

• DashboardDashboard– Single real-time, view of entire system by Single real-time, view of entire system by

application, backend, and system perspectiveapplication, backend, and system perspective

• Trend AnalysisTrend Analysis– Analyze trends in call volume, call types, system Analyze trends in call volume, call types, system

utilization, etcutilization, etc– Allows for point or spot analysisAllows for point or spot analysis

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THANK YOU!THANK YOU!

Elisa ElderbaumIT Business Advisor

National Government Services