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Toad Outsmarts Medicare Representatives

January 10, 2005
A toad -- just an ordinary toad, mind you -- provided more accurate responses to Medicare policy questions than Medicare customer service representatives, according to a new study by L.R. Huntoon, a practicing neurologist and editor-in-chief of the Journal of American Physicians and Surgeons.

Huntoon was inspired to conduct his research after reading a 2004 study by the Government Accountability Office (formerly the General Accounting Office).

It found that 96 percent of the time customer service reps (CSRs) gave the wrong answer to physicians questioning the appropriate way to bill Medicare.

In his follow-up study, Huntoon asked a toad a series of rephrased GAO Medicare policy questions. By jumping right for "yes" and left for "no," the toad crushed the competition, answering correctly 50 percent of the time.

In the GAO's 2004 study, the CSRs were aware of their evaluations and the questions were taken directly from the carrier's own website, yet, they still managed to lose to the toad 46 percent of the time.

While Huntoon's personal experiment is humorous, it illustrates the difficulties facing those who must deal withi the Centers for Medicare and Medicaid Services (CMS).

In 2003, Medicare received a total of 21 million "provider" inquiries; of those 21 million, Medicare's error rate would translate to 20,160,000 wrong answers.

CSRs are not held accountable for giving accurate information, says Huntoon. For that matter, there's no agreement on what is and isn't accurate. "CMS's definition of what constitutes accuracy is neither clear nor specific," the GAO reported.

With no accurate definition of accurate, it appears that CMS considers accuracy and competence to be irrelevant, says Huntoon.

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