December 8, 2004
A study by the Government Accountability Office (GAO) finds that the 1-800-MEDICARE help line falls far short of meeting older Americans' needs. GAO said the line provided accurate answers to 61 percent of the 420 calls it made and inaccurate answers to 29 percent.

No answers were available for the remaining 10 percent of the calls GAO's investigators made. 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 or the calls were inadvertently disconnected.

"There is a lesson for the Congress and the Administration in todays GAO report that less than two-thirds of people calling the governments Medicare information line received accurate answers," said Robert M. Hayes, president of the Medicare Rights Center, a not-for-profit advocacy organization.

"People with Medicare have been shunning the prescription drug discount card program in droves. Centers for Medicare and Medicaid Services trained counselors cannot provide useful information to millions of people confused by the new Medicare law. The drug benefit slated to begin in January 2006 will be even more confusing for older and disabled Americans," Hayes warned.

The 1-800-MEDICARE help line provides customer service reps (CSRs) with written answers - so-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 GAO's questions, the report said.

CMS and its contractor do not routinely pretest the scripts to ensure that they are understandable to CSRs or potential callers, GAO found.

To improve the accuracy of the information the help line provides, GAO recommends that CMS:

(1) revise procedures so that calls are not transferred to other contractors that are closed,

(2) assess current scripts and pretest new and revised scripts to ensure that they are understandable,

(3) provide more testing of customer service reps' ability to accurately answer questions and use the results to target training efforts as needed, and

(4) monitor the accuracy rate for each frequently asked question and use the results to modify scripts or provide training, if necessary.

GAO said that the training for CSRs meets CMSs 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, GAO said the results of its study indicate that the testing and simulated call answering did not sufficiently measure whether CSRs were prepared to answer questions accurately.