1-800-MEDICARE Provided Accurate Information for Less Than Two-thirds of the Calls We Placed

The 1-800-MEDICARE help line provided accurate answers to 61 percent  of the 420 calls we made. Overall, 29 percent of our calls were answered  inaccurately. We found instances when CSRs did not seem to access scripts when  responding to calls. For example, when responding to our calls concerning  the prescription drug discount card question, 2 CSRs indicated that they  were not able to inform the caller about which card had the lowest drug  prices—even though 53 other CSRs successfully used a script and a Web- based tool to answer this question. Ten Percent of Calls Were Not Answered, Often When Calls Were Transferred to Other Contractors’ Help Lines

We did not receive answers to our questions for 10 percent (42) of the 420  calls we placed at the time we originally called. The training for newly hired CSRs includes instruction on  accessing and using scripts, customer service etiquette, and information  about the Medicare program. Most of the training consists of 2 weeks of classroom instruction. After completing their initial  instruction, CMS requires the new CSRs to score at least 90 percent on a  written exam and successfully complete a call handling simulation  exercise before they answer calls on the help line without supervision. As a result, the monitoring does not assess how accurately  CSRs as a group answer particular questions, which could help CMS target  additional training efforts. Two smaller evaluation efforts did focus on  specific questions answered inaccurately, and these targeted monitoring  efforts provided information that CMS used to improve CSR training and  the scripts used on the help line. CMS’s Primary Contractor Monitors Performance of Individual CSRs

At the time of our review, CMS had delegated most of the responsibility for  monitoring the accuracy of the 1-800-MEDICARE help line to the primary  contractor, while maintaining oversight by reviewing the primary  contractor’s results. The study helped CMS identify questions that the CSRs were answering  less accurately. As a result of this study, CMS improved its scripts and related training. However, the  written exam that newly hired CSRs must pass and the continuing training  quizzes do not measure the ability to use information in scripts to provide  accurate and complete answers on the help line. Recommendations

In order to improve the accuracy of responses made on the 1-800- MEDICARE help line and callers’ ability to have their questions answered,  we recommend that the CMS Administrator take four actions:    Assess the current scripts for the most commonly asked questions to  ensure that they are understandable to CSRs and potential callers and if  not, revise them as needed and pretest new and revised scripts to ensure  that CSRs can effectively use them to accurately answer callers’ questions. This is the same tool CSRs used to answer our  questions. She is not enrolled in Medicaid.
Why GAO Did This Study

In March 1999, the Centers for Medicare & Medicaid Services (CMS) implemented a telephone help line--1-800-MEDICARE--to provide information about program eligibility, enrollment, and benefits. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) directed GAO to examine several issues related to this 24-hour help line and the customer service representatives (CSRs) who staff it. In this report, GAO evaluated (1) the accuracy of the information the help line provides, (2) the training given to CSRs, and (3) CMS's efforts to monitor the accuracy of information provided through the help line.

What GAO Found

The 1-800-MEDICARE help line provided accurate answers to 61 percent of the 420 calls we made and inaccurate answers to 29 percent. We were not able to obtain any answers for the remaining 10 percent of our calls at the time we placed them. Most of these calls were not answered because they were transferred to other contractors responsible for processing Medicare claims that were not open for business at the time we called or these calls were inadvertently disconnected. To facilitate accurate responses, the 1-800-MEDICARE help line provides CSRs with written answers--called "scripts"--that CSRs use during a call. When CSRs provided inaccurate information, it was largely because they did not seem to access and effectively use a script that answered our questions. CMS and its contractor do not routinely pretest the scripts to ensure that they are understandable to CSRs or potential callers. The training for CSRs meets CMS's requirements, but it is not sufficient to ensure that CSRs are able to answer questions accurately on the help line. Before handling calls, CSRs must complete about 2 weeks of classroom training; accurately answer two simulated calls consecutively out of six; and score at least 90 percent on a written exam. In addition, all CSRs receive ongoing training. However, the results from our calls indicate that the testing and simulated call answering did not sufficiently measure whether CSRs were prepared to answer questions accurately. CMS delegates most accuracy monitoring to one of its contractors and reviews the results. The bulk of the monitoring focuses on how accurately individual CSRs answer questions. However, this monitoring does not systematically track questions answered inaccurately by CSRs as a group, which could help target training and script improvement. Through two smaller studies that measured how accurately specific questions were answered, CMS was able to identify areas to improve scripts and training.