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1994.05.01 : Improving Customer Service in Medicare and Medicaid
Medicaid

Date: May 1994
Contact:  HCFA Press Office (202) 690-6145

            Improving Customer Service in Medicare and Medicaid

Overview:  As part of a strategic planning process, HHS' Health Care
Financing Administration has made customer service its highest priority.  HCFA
is reassessing customer needs through surveys and other contacts, and is
improving its publications.  A new electronic system for claims processing will
also enhance Medicare service.  HCFA's customers include more than 36 million
Medicare and over 34 million Medicaid beneficiaries.

HCFA defines its overall mission as ensuring health care security for beneficiaries by
achieving the following goals:

          Ensuring access to affordable and quality health care services;

          Protecting the rights and dignity of beneficiaries; and

          Providing clear and useful information to beneficiaries and providers
          to assist them
          in making health care choices.

HCFA is reaching out to customers to learn how to serve them better.  A number of recent
and new activities will provide HCFA with a foundation for improvements in beneficiary
services.

In an attempt to make the Medicare program more responsive to beneficiaries,
HCFA recently established 15 focus groups comprised of Medicare beneficiaries,
health representatives and special-need populations.  These groups have shown
that beneficiaries like the security of the Medicare system but feel that information
dissemination and communication are major problems.  As a result, HCFA is
working to improve its information and communications programs for both
beneficiaries and providers.

A beneficiary survey is being piloted in five geographic areas to solicit information
from beneficiaries about the services they receive from carriers -- insurance
companies under contract with HCFA to process Medicare claims and perform
other customer services for beneficiaries.  The results of the surveys will be
available by the end of this year.

HCFA staff recently interviewed and obtained completed questionnaires from
beneficiary services representatives in each region to measure the extent of
customer service/outreach activities in the 10 HCFA Regional offices and to
determine what support the central office could provide for these activities.  A
number of new projects are being considered as a result of the study.

Quarterly meetings will be held with beneficiary advocacy and consumer groups to
solicit input and feedback on beneficiary concerns.

HCFA is launching an extensive evaluation process for its publications.  This process will
examine whether the current HCFA publications meet all of the needs of beneficiaries, and
whether they are easy for beneficiaries and others to understand.

The Medicare Handbook is published annually and  furnished to all new Medicare
enrollees.  It offers a comprehensive overview of Medicare services as well as
information on premiums, deductibles and coinsurance.  The Medicare Handbook
is published in both English and Spanish, and is available on audio tape for the
visually impaired.

The Guide to Health Insurance for People with Medicare is also published annually
and provides information to help beneficiaries choose policies to supplement their
Medicare coverage.  This publication is available in both English and Spanish, and
on audio tape.

Other HCFA publications include:  the Guide to Choosing a Nursing Home; the
Guide to Coverage of Kidney Dialysis and Kidney Transplant Services; and
Medicare Q's & A's:  85 Commonly Asked Questions.

HCFA publications can be obtained by calling 1-800-638-6833.

A new national electronic system for claims processing will improve services to Medicare
beneficiaries.

On Jan. 19, 1994, HCFA awarded a six-year contract for designing and
implementing a national, standard, integrated Medicare Transaction System (MTS)
that will begin operations in late 1996.

By assuming claims-processing functions currently performed by 79
contractors, MTS will bring greater uniformity in the application of
coverage and payment policies.

The new system will provide a single, easily accessible source of
information on Medicare benefits, payment decisions and status of claims.

Beneficiaries with Medigap policies or health plans other than Medicare
will no longer have to worry about coordination of the different plans.  The
MTS will automatically send information to other payers.

HCFA requires high-quality performance from contractors that process claims and provide
other services to beneficiaries and health care providers.

In evaluating the performance of contractors, HCFA emphasizes quick and
accurate responses to inquiries from beneficiaries.

HCFA's recent reorganization has placed a greater emphasis on beneficiary services.

Under HCFA's reorganization, the former associate administrator for
communications has become the associate administrator for customer relations and
communications (AACRC). 

HCFA's reorganization created an office of beneficiary services.  This office falls
under AACRC and works with HCFA components as well as beneficiary and
consumer groups to identify and assess beneficiaries needs for information, benefits
and services.
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