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NEW JERSEY MEDICARE

BENEFICIARY SATISFACTION

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OFFICE OF INSPECTOR GENERAL 
OFFICE OF EVALUATION AND INSPECTIONS 
OCTOBER 1990  , " 
OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG) is to promote the efficiency, 
effectiveness and integrity of programs in the United States Department of Health and Human 
Services (HHS). It does this by developing methods to detect and prevent fraud, waste and 
abuse. Created by statute in 1976, the Inspector General keeps both the Secreta and the 
Congress fully and currently informed about programs or management problems and 
recommends corrective action. The OIG performs its mission by conducting audits 
investigations and inspections with approximately 1,400 staff strategically located around the 
countr. 
OFFICE OF EVALUATION AND INSPECTIONS 
This report was produced by the Office of Evaluation and Inspections (OEI), one of the three 
major offices within OIG. The other two are the Office of Audit Services and the Offce of 
Investigations. The OEI conducts inspections which are typically short-term studies designed 
to determne program effectiveness, efficiency and vulnerability to fraud or abuse. 
The report is entitled  New Jersey Medicare Beneficiar Satisfaction.
" This inspection 
requested by the Health Care Financing Administration, sought to determine beneficiary 
satisfaction with the Medicare program in New Jersey. 
This study was conducted under the direction of Thomas F. Tully, Regional Inspector General 
of Region II, Office of Evaluation and Inspections. Paricipating in this project were the 
following people:

Region /I  Headquarters 
Jack Molnar Project Leader  Vicki Greene 
Jodi Nudelman 
Brian Ritchie 
Tracey Rennie 
Willam Counihan 
Nancy Harson 
For additional copies of this report, call Jack Molnar, the project leader, at (212)264-1998.  NEW JERSEY MEDICARE

BENEFICIARY SATISFACTION

Richard P. Kusserow 
INSPECTOR GENERAL 
OEI-02-90-02040  OCTOBER 1990  EXECUTIVE SUMMARY 
PURPOSE 
To determne beneficiar satisfaction with the Medcar program in New Jersey. 
BACKGROUND 
This inspection was conducted at the request of the Health Car Financing Admnistration 
(HCFA). Following the change of carers in New Jersey at the beginning of 1989, HCFA 
received complaints from the New Jersey Congressional delegation and from the 
physiciansupplier community. In response, HCFA asked the Offce of Inspector General 
(OIG) to survey the level of satisfaction with Medcare services among New Jersey 
beneficiares. 
This survey follows two simlar sureys conducted by OIG in 1989. The first surey was of 
Medicare beneficiares nationwide; the second was limited to Georgia, which also had a recent 
change in Medcar carer. 
METHODOLOGY 
A questionnaie was mailed to 641 radomly selected New Jersey beneficiares who had fied 
claims with Pennsylvania Blue Shield in 1989. The response rate was 73. 8 percent. New 
Jersey responses were compared to Georgia and national results where appropriate. 
FINDINGS 
Overal, New Jersey beneficiares are satisfied with servces. Specifically, they are satisfied 
nee it. Furer 
with the claims processing and report that information is available when they 
they like and use the 8oo-toll-fre telephone number, but some problems were noted. In 
virually all areas, the fmdings for New Jersey beneficiares are comparable to those in earlier 
OIG reports for nationwide and Georgia beneficiares. 
AGENCY COMMENTS 
drt 
HCFA commented on the  report. cOverall, HCFA is pleased that the surey results reflect 
moded 
positively on the efforts of Pennsylvania Blue Shield. The report was  based on 
HCFA' s suggested clarcations. The full text of HCFA' s comments ar attched.  ..... ....... ....... ..... ......... ................ .... ............ .... ......... .......... ............ ......... .  .............. ....................    ...... .....................  ......................  ............  ...... .......... ..... .. .... ..................................... ........ ...... .................. ............... ........... ......................... .........................
................. ........ .... ......  ............. ........... .... ...... .... 
TABLE OF CONTENTS 
EXECUTIVE SUMMARY

I NTRO DU CTION .... ........ ................. .................. 

................................................. 1

......... .... ........ ............ 1

PU R POSE........ 

BACKG ROU N D ....................... .......... ....... ........ 
................................ .................... 1

M ETHO  V ... ..... 
DOLOG 
FI N DI NGS................... 

New Jersey Beneficiaries Express 
Overall Satisfaction with Services............................................... 3

Beneficiaries are satisfied with claims processing .........................

Beneficiaries report information is readily 
available......................... 4

Beneficiaries know of and use the toll-
free number......................... 5

Beneficiaries rate Medicare services good or very good .................

AGENCY 
CO M ME NTS 
X A........ ........... ..... ........ ..... ....  ............... .... ........ ... .... ...... ....... A 
APP EN DI 
 - 1

B..... ............ .... ......  ... B

APP EN DIX 
 INTRODUCTION

PURPOSE 
To determine beneficiar satisfaction with the Medicare program in New Jersey. 
BACKGROUND 
billon. 
Medicare, a Federal health insurance program for people 65 or older and certain disabled 
people, serves over 33 milion people, and in Fiscal Year 1987 paid benefits in excess of $79
The Medicare program has two pars. Hospital insurance (Par A) helps pay for inpatient 
home health care and hospice 
hospital care, some inpatient care in a skiled nursing facilty, 
care. Medical insurance (Par B) helps pay for medically necessar doctors ' services, 
outpatient hospital services, home health care and a number of other medical services and 
supplies not covered by the hospital insurance par of Medicare. A person entitled to 
Medicare automatically receives coverage under Pa.'1 A. Par B, however, is optional and 
beneficiares pay a monthly premium. Both pars of Medicare have deductible and 
coinsurance requirements.

The Health Care Financing Administration (HCFA) is responsible for the Medicare program. 
The Social Security Administration (SSA) shares responsibilty by establishing eligibility, 
enrollng beneficiares and collecting premiums for Par B coverage. For claims 
administration, the Federal government contracts with private insurance organizations. The 
companies which handle Par A claims are called intermediares; those handling Par B claims 
are called carers. 
In 1989, the Office of Inspector General (OIG) conducted a national survey of Medicare 
beneficiares to assess their experience and satisfaction with the Medicare program. Also in 
1989, HCFA changed carers in Georgia and requested the OIG to survey beneficiar 
satisfaction with services provided by the new Medicare carer. Both studies found that 
Medicare beneficiares were generally satisfied with services. 
As of Januar 1, 1989, carers also changed in New Jersey, with Pennsylvania Blue Shield 
replacing the Prdential Company. The new carer, however, has received criticism from 
members of the New Jersey Congressional delegation and the physician/supplier community. 
In response, HCFA requested that the OIG determine the level of satisfaction of New Jersey 
beneficiares.  METHODOLOGY 
A questionnaire was mailed in March 1990 to 641 randomly selected New Jersey Medicare 
beneficiares who had filed claims with Pennsylvania Blue Shield in 1989. The sample size 
was the same for the National and Georgia studies. 
The sample was reduced to 619 because 21 respondents were deceased and 1 was erroneously 
selected. In all, 457 questionnaires were completed, representing a 73.8 percent response rate. 
The survey questioned beneficiares about three general areas: claims processing, aval1ability 
of infonnation, and telephone service. Twenty-three survey questionscwere taken from the 
national OIG inspection, "Survey of Medicare Beneficiar Satisfaction." The New Jersey 
responses to these questions were compared to both the Georgia and national study results. In 
addition, two new questions were taken from previous OIG annual Social Security client 
satisfaction studies and responses to them were compared with those of Social Security clients.  FINDINGS 
New Jersey Beneficiaries Express Overall Satisfaction with Services. 
Beneficiaries are satisfied with claims processing. 
Eighty-six percent of New Jersey beneficiares surveyed report that they are very or generally 
satisfied with the way Medicar has processed their claims. This is comparable to the 85 
percent Georgia response and the 88 percent nationwide rate obtained when those Medicare 
beneficiares were asked the same question.

SATISFACTION WITH CLAIMS PROCESSING 
% GENERALLY OR VERY SATISFIED 
100 
NEW JERSEY  GEORGIA  NATION 
Three-quarers of New Jersey beneficiares report their clais are processed quickly enough; 
this is virtually identical to the responses given by beneficiares nationally and by those from 
Georgia. New Jersey beneficiares are less likely to seek help in completing their claims than 
beneficiares nationally. Fifty-eight percent of New Jersey beneficiares report they "never 
need help completing the claims form. The comparable figure was 41 percent for 
beneficiares nationaly.

The sources of help in filing out Medicare claim forms for New Jersey beneficiares are 
similar, but not identical, to those for beneficiares nationally. While both groups would go to 
their doctors first, it appears that NewJersey beneficiares would be more likely to rely on the 
carer and friends and less likely to rely on Social Security field offices than beneficiares 
across the nation.  SOURCES OF HELP WITH CLAIMS 
National 
Doctor 
71%  69% 
Carer 
61%  53% 
Friend 
46%  33% 
Social Security  42%  51% 
Senior Center 
30%  29% 
The most common problems reported by New Jersey beneficiares are (1) understanding the 
amount paid on their claims (49%), and (2) determining how much should be paid by other 
insurance (36%). These were also the most common problems reported by nationwide 
beneficiares. 
Beneficiaries report information is readily available. 
Eighty-six percent of New Jersey beneficiares report they can get information when they need 
question, Georgia and national beneficiares report 83 and 85 percent rates 
it. In a similar 
respectively. The majority of beneficiares who sought information report that they were able 
to get it when needed. Sixty percent of those who needed information say most of the time 
they can get information; 29 percent say some of the time. 
AVAILABILITY OF MEDICARE INFORMATION 
% CAN GET INFORMATION

100 
NEW JERSEY  GEORGIA  NATION  New Jersey beneficiares, however, do not go to the same places for infonnation as 
beneficiares do nationally. They are more likely to go to the carer and to refer to the 
Medicare Handbook, and are less likely to go to Social Security offices than beneficiares 
across the nation. 
SOURCES OF INFORMATION 
National 
Carer 
80%  51% 
Handbook 
78%  63% 
Social Security  69%  77% 
Of the three-quarers of New Jersey beneficiares who recal receiving pamphlets on 
Medicare, 91 percent rate them as "generally helpful." This is virually identical to the 
national rating. New Jersey beneficiares also rate the quality of the pamphlets highly. 
Eighty-eight percent say they are easy to understand, 82 percent report they provide suffcient 
infonnation, and 94 percent believe the prit is large enough. 
Beneficiaries know of and use the toll-free number. 
Seventy percent of New Jersey beneficiares are aware of the toll-free number for their carer 
as listed in the Medicare Handbook. Half of the beneficiares nationally knew of the number. 
New Jersey beneficiares are also more likely to use this number. While 47 percent use it in 
New Jersey, less than a third of th  nationwide and Georgia beneficiares use the toll-free 
number. 
Further, of the New Jersey beneficiares who use the toll-free number, 79 percent are generaly 
or very satisfied with the service they receive. Seventy-one percent of Georgia s and 80 
percent of national beneficiares are generally or very satisfied with telephone service. 
However, New Jersey beneficiares repon some problems with the toll-free number. These 
problems are simiar to those expressed by national and Georgia beneficiares. Specifically, 
three-quarers of New Jersey beneficiares who indicated they called the hotline, report that 
the line was busy the last time they called. The figures for nationwide and Georgia 
beneficiares are 71 and 70 percent respectively. About 60 percent of the New Jersey 
beneficiares who called the hotline, report being put on hold too long, which is identical to 
the findings in the other two surveys.  800 # 
SATISFACTION WITH 
% GENERALLY OR VERY SATISFIED 
100 
NEW JERSEY  GEORGIA  NATION 
Most beneficiaries rate Medicare services good or very good. 
Seventy-eight percent of New Jersey Medicar beneficiares rate overall Medicare services 
good or very good. While there is no comparable data for nationwide and Georgia 
beneficiares, this rating is similar to the 83 percent average rating given by Social Security 
clients over the past six years. 
SATISFACTION WITH SERVICES 
% GOOD OR VERY GOOD 
100 
NJ MEDICARE  SSA  When asked to compare Medicare services to other services from Federal, State and local 
government agencies, 95 percent of New Jersey Medicare beneficiares say the services they 
receive are as good as, or better than, those received from other government agencies. This 
compares to 94 percent of nationwide Social Security clients. 
AGENCY COMMENTS 
HCFA commented on the draft report. Overall, HCFA is pleased that the survey results reflect 
positively on the efforts of Pennsylvania Blue Shield (PBS) to encourage beneficiar contact 
and promote beneficiar education. HCFA also found the survey s identification of provider 
relations as the likely predominant source of Congressional concerns about PBS to be 
extremely helpful. 
The report was modified based on HCFA's suggested clarfications. The full text of HCFA' 
commen ts are attached.  APPENDIX A

question  percentage 
NJ#  NTL 
In general do you think: 
a. The Medicare program is understandable 
YES  369 
b. You can get information about Medicare when you need it 
YES  376 
c. Medicare payment policies are understandable 
YES	 334 
106 
d. Medicare pays your claims quickly enough 
YES	 330 
107 
Do you or your spouse have other medical insurance that covers your medical 
expenses in addition to what Medicare covers? 
MEDICAID 
PRIVATE INSURANCE 
TO SUPPLEMENT MEDICARE  355 
from
CHAMPUS 
OTHR 
the Federal 
Do you recall getting any pamphlets or handbooks in the mail 	
Government or notices enclosed with your Social Security check that describe the 
Medicare program? 
124 
YES  303 
Thinking about those pamphlets, handbooks and notices with your check were 
most of them: 
GENERALLY HELPFU  256 
GENERALLY NOT HELPFU 
NJ = New Jersey GA = Georgia  NT = National  x = Was not asked 
SSA = Social Security Administration 
NOTE:  Questions  11  and  13  required a narrative response and are not included.  question  percentage 
GA 
NJ#  NTL 
Thinking about the pamphlets, handbooks and notices you have received would 
you say that: 
a. The wording is easy to understand 
YES  249 
b. The amount of information covered is suffcient
YES
NO
224 
c. The lettering is large enough to read 
YES  266 
Next, we would like to ask about times when you have needed to get specific 
information about your own Medicare coverage. How often were you able to get 
the information you needed? 
TH 
MOST OF  TIME	 159 
TH 
SOME OF  TIME 
SELDOM OR NEVER 
I HAVE NEVER NEEDED 
TO GET INFORMATION  157 
The following are some places people might go to get answers if they have 
questions about their Medicare coverage. Would you be likely to go to any of the 
following: 
a. The insurance company that processes your Medicar claim
YES
NO
307 
b. The Medicare Handbook 
YES  265 
c. The Social Security office 
YES	 243 
110  question	 percentage 
NJ#	 NTL 
d. A frend or relative 
YES	 103 
202 
e. An insurance salesperson 
YES 
274 
f. A senior citizens 
' group 
YES	 117 
197 
10.	 Do all of your doctors submit your Medicare claims for you so that you do not 
have to submit the claims yourself? 
TH TIM 
ALL OF  102 
TH 
MOST OF  TIME  101 
SOMETIMES  155 
SELDOM OR NEVER 
12.	 Overall, how satisfied are you with the way Medicare has processed the claims you 
have submitted? 
VERY SATISFIED 
GENERALLY SATISFFED  187  62 
GENERALLY DISSATISFID

VERY DISSATISFIED 
14.	 Do you get help fillng out your Medicare claim forms? 
TH 
ALL OF  TIME 
TH 
SOME OF  TIME 
NEVER  189 
15.	 Listed below are some places people might go to get help fillng out Medicare claim 
forms. If you needed help in fillng out your Medicare forms would you be likely 
to get help from any of the following? 
a. A frend or relative 
YES	 110 
129 
A- 3
 question  percentage 
NJ#  NTL 
b. Your doctor s offce 
YES  190 
c. A Social Securty offce 
YES	 100 
136 
d. A senior citizens ' center 
YES 
153 
e. The insurance company that processes your Medicare claims 
YES	 155 
101 
16. The following are possible reasons why someone might be dissatisfied with Medicare 
claims. Have any of the following been a problem for you? 
a. Fillng out Medicar claims 
YES 
243 
b. Getting information on the status of your claim 
YES 
1991  9 

c. Determning how much should be paYid bEy otSher 1insur7ance y8ou have 
NO
d. Understanding what Medicare paid oYn yoEur Sclaims and why
NO 	
141
147 
17.	 There is a toll-free number in your Medicare Handbook that you can use to 
telephone the insurance company to get information about your Medicare claims. 
Did you know about this toli-free number before today? 
134 
YES  309  question  percentage 
GA 
NJ#  NTL 
18.	 Have you ever used this toll-free number to get information about Medicare 
claims? 
237 
YES  209 
19.	 Thinking about the last time you used this toll-free number, how satisfied were you 
with the service you received? 
VERY SATISFIED

GENERALLY SATISFIED

GENERALLY DISSATISFID

VERY DISSATISFIED 
20.	 Listed below are possible reasons that someone would be dissatisfied with this 
toll-free service. Did you have any of the following problems the last time you 
called the toll-free number? 
a. Line was busy

YES  137

b. Put on "Hold" too long

YES  103

40 . 
c. Answers given were not understandable 
YES 
125 
d. Answers given were not correct 
YES 
132 
e. Person answering call was not very courteous 
YES 
122 
A- 5
 question  percentage 
GA 
NJ#  NTL 
21.	 Sometimes people disagree with the decision made on their Medicare claims. 
When this happens, you may appeal or request a review of those decisions. Did 
you know before today that you could appeal or request a review? 
YES  340 
22.	 In the past year have you appealed a decision made by Medicare/PA Blue Shield on 
a claim you submitted? 
288 
YES 
23.	 Overall, how would you rate the service that Medicare/PA Blue Shield has given 
you? 
NJ#	 SSA 
VERY GOOD  165

GOOD  186

FAIR 
POOR 
VERY POOR 
24.	 How would you rate Medicare/PA Blue Shield's service compared to the service 
you get from other Federal, State, and local government agencies? 
MedicarelPA Blue Shield is much

better than others

MedicarelPA Blue Shield is

somewhat better than others

MedicarelPA Blue Shield is

about as good as others  129

MedicarelPA Blue Shield is

somewhat worse than others

MedicarelPA Blue Shield is

much worse than others

A- 6
 question  percentage 
GA 
NJ#  NTL 
25.  Is there anything else you want to tell us about Medicare, or PA Blue Shield? 
Positive Comments 
Negative Comments 
Mixed Comments  APPENDIX B

Respondents Versus Non-Respondents 
Analysis  of 
Our original sample of 641 beneficiares was reduced to 619 by eliminating 21 deceased 
beneficiares and 1 beneficiar covered under the Raioad Board Retiement System. Of the 
619 questionnaires This represents a response rate of73. 
, 457 were returned to our offce. 
percent. An important consideration in sureys of this type is the bias that may be present in 
the results if the non-respondents are different than the respondents. To test for the presence 
of any bias, we compared responders with non-responders, for certain varables, and attempted 
to determine how any diffetences might affect the results. The varables tha:t we decided to 
compare were age, sex, race, medicare status, total charges, and total reimbursed amounts. 
The categorical varables were tested using a Chi-square with the appropriate degrees of 
freedom. The continuous varables (age, charges, and reimbursements) were tested using a 
two-tailed t-test. 
The results of the analysis for the thee categorical varables are presented in Table 1. The 
Chi-square values given in the table provide a test of the difference in the 
distrbution of the 
respondents versus the non-respondents for each varable. The table also shows the response 
rates by the different values of the varables. The analysis shows that there are significant 
differences in response rates between aged persons and the disabled, and between whites and 
nonwhites. The difference in response rates by Medicare status (aged, disabled, or ESRD) is a 
result of the low response rate for disabled beneficiares (41.7 %) compared to that for aged 
beneficiares (75.9%). The diference in response rate by race is due to the low response rate 
for non-white beneficiares (58.5%), versus that for white beneficiares (75.7%). 
In order to determine if these differences may have biased our results, we tested the effects on 
several of the survey s key questions. The questions selected for analysis were: 
Is Medicare understandable?

Can you get information when you need it?

1.c.	 Are Medicare payment policies understandable?

Are claims paid quickly enough?

One method to determine the effects the non-respondents might have is to assume that their 
responses would have been similar to respondents of the same medicare status or race. Under 
this assumption, the changes in the proporton of beneficiares that answered "yes" to the 
questions are presented in Table 2 for medicare status.  TABLE 1 
New Jersey Medicare Beneficiary Survey

ReSDonders VS Non-ReSDonders

MEDICARE STATUS

Non  Percent 
Responders  Responders  Total  Responding 
Aged  440  96.3%  140  86.4%  580  75. 
Disabled 
3.3%  13.  41.7% 
ESRD  0.4%  66. 
457  162  619  73. 
CHI-SQ = 20.531* 
E = 1

SEX 
Non  Percent 
Responders  Responders  Total  Responding 
Male  178  38.  38.  240  74.2% 
Female  279  61.1 %  100  61.7%  379  73. 
457  162  619  73. 
CHI-SQ = 0.023 
E = 1

RACE 
Non  Percent 
Responders  Responders  Total  Responding 
White  412  90.2%  132  81.5%  544  75. 
Non-White 
16.  58. 
Unknown  1.5%  1.9%  70.05% 
457  162  619  73. 
CHI-SQ=8.980 
E=1 
*Significant AT P -c 0.001; ESRD Status excluded from calculation. 
Significant AT P -c 0.001; Unkown Status excluded from calculation.  TABLE 2 
Medicare Status

Percent  Adjusted Percent 
Question  Answering Yes  Answering Yes 
1.a.  80.  80.3% 
1.b.  82.  81.8% 
1.c.  73.  72.4% 
1.d.  72.  71.8% 
Given the fact that these changes are so small, we feel that the medicare status difference 
between respondents and non-respondents has essentially no effect on the outcome of this 
survey. The same analysis of changes in the proportion of beneficiares that answered "yes" to 
the questions is presented in Table 3 for race. 
TABLE 3 
Race 
Percent  Adjusted Percent 
Question  Answering Yes  Answering Yes 
1.a.  80.  80. 
1.b.  82.  82. 
1.c.  73.3%  73. 
1.d.  72.  72. 
Again, because the changes are this small, we feel that the race difference between responding 
and non-responding beneficiares has no overall effect on our results. 
Turning to the continuous varables, we found that the average age of those beneficiares 
responding to the survey was 74. 1 years, while that of beneficiares not responding was 73. 
years. This difference is not significant. We also compared total charges and total Medicare 
reimbursed amounts for calendar year 1989. The average total charges was $439 for 
respondents and $477 for non-respondents, while the average reimbursed amount was $357 
for respondents and $388 for non-respondents. Neither of these differences proved to be 
statistically significant.  Given the results from these analyses, we believe that the results presented accurately 
represent the opinions of the sample of clients that were sent questionnaires. It is possible that 
those beneficiares who chose not to respond may, in some fashion, differ from those 
responding to the survey. However, we do not have the information necessar to determine if 
and to what extent, differences exist. In any event, the non-respondents represent a minority 
of the beneficiares contrbuting to this analysis. Therefore, we feel that these results give a 
reliable picture of the opinions of the universe of New Jersey beneficiares that are covered by 
Pennsylvania Blue Shield. 
B 
 &. 
Health Care 
HUMAN SERVICES  Financing Administration 
DEPARTMENT Of HEALTH 
Memorandum 
.\ur; I 0 1990
Date 
Deputy Director.
From 
Bureau . of Program Operations 
Subject Comments on the OIG Draft Report: New Jersey Medicare 
(OEI-02-90-02040) --INFORMTION 
Beneficiary Satisfaction 
Chief 
Heal th Care Branch, OIG

Thank you for fulfilling our request for an evaluation of

beneficiary satisfaction with the Medicare program in

New Jersey (NJ) following the transition to a new carrier.

We submit the following comments on the subject draft

report for your consideration. Comments from our

Philadelphia Regional Office have been included in our

response. Many of these concerns were discussed at our

June 25th meeting with OIG. We appreciate the opportunity 
to comment on this draft report. 
and Comments

General ebserva tions 
We are pleased that the survey results reflect

positively on the efforts of pennsylvania Blue Shield

(PBS) tD encourage beneficiary contact and promote

beneficiary education.

of provider

We find the survey s identification 
source of
relations as the likely predominant

be extremely

congressional concerns about PBS to
helpful. 
the narrative which

We suggest that eIG indicate in  of all 
questions were responded to by only a portio 
beneficiaries surveyed. 
be more easily

We believe that Appendix I would 
interpreted if the number of respondents to each

question could be provided.

We suggest that eIG consider correlating the findings

reported in the narrative with tuhsein cgo rforeostnpoontdeisn.g

questions listed in Appendix I 
 Specific Comments

paqe One

Stating that "HCFA changed carriers" in Georgia and 
New Jersey may give the impression to uninformed
In reality,

readers that HCFA initiated the changes. 

the changes were initiated by the Prudential

Insurance Company, which informed HCcFaAr riien rA.pril 1988

that it would no longer serve as a 

paqe Three

It is noted in the first paragraph that 58% of NJ

beneficiaries " never " need help completing claim
forms. 
So, at most, 42% of NJ beneficiaries need 
help completing claim forms at least some of the
time. 
The table below that paragraphf olrimstss.  sources
Some of 
beneficiaries use to complete claim  42%, which
the numbers in the table are greater than 
is confusing. As we understand it, these num1b5e rins  
responses to Question 
were derived from the 
Appendix I and actually measure the relative 
confidence that beneficiaries have in the various 
potential sources df information, rather than the

number of beneficiaries who actually use each of the

sources. 
paqe Five 
tati ve

There is a discrepancy between the quanti

full paragraph

information presented in the second  page. The 
and that in the graph at the bottom of thetransposed.
values for Georgia and for the nation are 
Of the 47% of NJ beneficiaries who have used the

past, a full 79%

toll-free inquiry number in the  were 
19, that they c
reported, in response to Question

generally or very satisfied "the last time" they 
called the number. At the same time, the responses 
indicate that a high 
to Questions 20a and 20b 
percentage of NJ beneficiaries experienced a busy 
was-
what they felt 
signal or were left on hold for 
too long" the last time they called.
 It is contradictory that a high percentage of

beneficiaries could be both satisfied and

dissatisfied with their last call to the toll-free

number. It seems reasonable to believe that NJ 
beneficiaries indicated their general level of
toll- free 
satis faction with the  number in response to 
19. 
20, NJ 
Question  Responding to Question 
sking 
beneficiaries may have interpreted it to be 

whether they had ever experienced any of the

specified problems. We suggest that OIG ignore the 
phrase, " the last time , in its interpretation and 
surveys. 
omi t  it from future 
1990 meeting with OIG, we

Based on our June 25, 
only a small portion

understand that, in actuali ty,  20. We

of the survey respondents answered Question
this point

further understand that OIG will emphasiz

in its final report.

Appendix I 
It would be helpful if OIG noted here that Questions

5, 8, 11 and 13 are not included because they

response. 
required a narrative 
Survey Question 11 asked each NJ beneficiary to 
estimate the number of claims he/she submitted in
1989. It 
would be interesting to know whether high-
volume users of PBS' s services are, generally

speaking, more or less satisfied with PBS thvaonlu mloe w-

volume users are. It would seem that high-

users might account for most of the total NenJc.o unters

Does 
between the carrier and beneficiaries in

regard?
OIG have any data in this 

Appendix II 
OIG analyzed how certain variables are related to the 
probability that a given beneficiary would or would 
survey. 
Once the critical 
not respond to the 
variables were identified, OIG corrected for the
under-reporting by some groups by assuming that non-
respondents in these groups would respond in the way 
that respondents did.  adjustment, we note that it

While we agree with this 
still doesn t address the issue of possible survey

bias arising from different attitudes of rreessppoonnddeennttss
 
and non-respondents. It may be that non-
have fewer complaints, regardless of race, Medicare
do.
status, etc., than respondents 

We are pleased with the positive overall findings of DIG'
review. 
Again, thank you for the opportunity to review the
draft report. 
Questions about this response should be
646-6121.
directed to Dorothy Kielkopf on 

CJ"Q 
Carol J . Walton