"- c_


NEW JERSEY MEDICARE


BENEFICIARY SATISFACTION


t"RV'CE$. ljJ' 

'0 

IiVd:m 

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 

with the claims processing and report that information is available when they nee it. Furer 

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 

HCFA commented on the drt report. cOverall, HCFA is pleased that the surey results reflect 

positively on the efforts of Pennsylvania Blue Shield. The report was moded 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


PU R POSE........ 
 ......... .... ........ ............ 1


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


M ETHO DOLOG V ... ..... 

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


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


AGENCY CO M ME NTS 

APP EN DI 
 X A........ ........... ..... ........ ..... .... ............... .... ........ ... .... ...... ....... A - 1


APP EN DIX 
 B..... ............ .... ...... ... B­

INTRODUCTION


PURPOSE 

To determine beneficiar satisfaction with the Medicare program in New Jersey. 

BACKGROUND 

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 billon. 

The Medicare program has two pars. Hospital insurance (Par A) helps pay for inpatient 

hospital care, some inpatient care in a skiled nursing facilty, home health care and hospice 

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 questionsc were 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 

it. In a similar question, Georgia and national beneficiares report 83 and 85 percent rates 

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. 
SATISFACTION WITH 800 # 

% 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 

NJ# 

percentage 

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 

fromCHAMPUS 

OTHR 

Do you recall getting any pamphlets or handbooks in the mail 	 the Federal 

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 

NJ# GA 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 NO224 

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? 

MOST OF TH TIME	 159 

SOME OF TH 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 NO307 

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? 

ALL OF TH TIM 102 

MOST OF TH 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 

GENERALLY DISSATISFID


VERY DISSATISFIED 

14.	 Do you get help fillng out your Medicare claim forms? 

ALL OF TH TIME 

SOME OF TH 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


62 
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 

191 

c. Determning how much should be paid by other insurance you have 

NOYES178 99 


d. Understanding what Medicare paid on your claims and why YES 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 

NJ# GA 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 

NJ# GA 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? 

VERY GOOD 

GOOD 

FAIR 

POOR 

VERY POOR 

NJ#	 SSA 

165


186


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 

NJ# GA 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


Analysis of Respondents Versus Non-Respondents 

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, 457 were returned to our offce. This represents a response rate of73. 

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 

DEPARTMENT Of HEALTH HUMAN SERVICES Financing Administration 

Memorandum 

.\ur; I 0 1990 Date 

From Deputy Director.

Bureau . of Program Operations 

Subject Comments on the OIG Draft Report: New Jersey Medicare 

Beneficiary Satisfaction (OEI-02-90-02040) --INFORMTION 

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. 

General ebserva tions and Comments


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.


We find the survey s identification of provider


source of relations as the likely predominant


congressional concerns about PBS to be extremely


helpful. 

the narrative which
 We suggest that eIG indicate in of all 

questions were responded to by only a portio 

beneficiaries surveyed. 

We believe that Appendix I would be more easily


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 the corresponding
 using footnotes. 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 HCFA in April 1988
 carrier. 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 paragraph lists sources forms. Some of beneficiaries use to complete claim 42%, which the numbers in the table are greater than 

is confusing. As we understand it, these numbers 

were derived from the responses to Question 15 in 

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


toll-free inquiry number in the past, a full 79%


19, that they c were 

reported, in response to Question
 generally or very satisfied " the last time " they 

called the number. At the same time, the responses 

to Questions 20a and 20b indicate that a high 

percentage of NJ beneficiaries experienced a busy 

signal or were left on hold for what they felt wastoo 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 satis faction with the toll- free number in response to 

Question 19. Responding to Question 20, NJ 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 

omi t it from future surveys. 

Based on our June 25, 1990 meeting with OIG, we


understand that, in actuali ty, only a small portion
 20. We


of the survey respondents answered Questionthis 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


required a narrative response. 

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 highvolume users of PBS' s services are, generally


speaking, more or less satisfied with PBS than low-
 volume volume users are. It would seem that high-


users might account for most of the total encounters
 NJ. 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 

not respond to the survey. Once the critical 

variables were identified, OIG corrected for the

under-reporting by some groups by assuming that nonrespondents in these groups would respond in the way 

that respondents did. 
While we agree with this adjustment, we note that it


still doesn t address the issue of possible survey


bias arising from different attitudes of respondents


and non-respondents. It may be that non-respondents 

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