Medical services rates (41 - 50 of 111 items)
Medicaid: Tennessee's Program Broadens Coverage but Faces Uncertain Future
HEHS-95-186: Published: Sep 1, 1995. Publicly Released: Sep 19, 1995.
Pursuant to a congressional request, GAO reviewed Tennessee's Medicaid capitated managed care program (TennCare), focusing on: (1) TennCare's basic design and objectives; (2) the degree to which the program is meeting these objectives; and (3) the experiences of TennCare insurers and medical providers and their implications for TennCare's future.GAO found that: (1) TennCare's objectives are to exp...
Medicare Competitive Bidding
HEHS-95-238R: Published: Aug 11, 1995. Publicly Released: Aug 11, 1995.
Pursuant to a congressional request, GAO examined how Medicare could effectively use competitive bidding to set medical services and supply prices and achieve savings. GAO noted that: (1) competitive bidding has been effective in controlling the costs of the Department of Veterans Affairs' oxygen supplies, Arizona Medicaid capitation rates, and state supplemental food programs; (2) although no com...
Medicare: Adapting Private Sector Techniques Could Curb Losses to Fraud and Abuse
T-HEHS-95-211: Published: Jul 19, 1995. Publicly Released: Jul 19, 1995.
GAO discussed Medicare's continuing vulnerability to questionable, abusive, and exploitative provider billing. GAO noted that: (1) Medicare is vulnerable to abusive billing because it has higher-than-market rates for certain supplies and services, inadequate fraud and abuse detection procedures, inadequate criteria for confirming the authenticity of providers billing the program, and lengthy delay...
Medicare Managed Care: Enrollment Growth Underscores Need to Revamp HMO Payment Methods
T-HEHS-95-207: Published: Jul 12, 1995. Publicly Released: Jul 12, 1995.
Pursuant to a congressional request, GAO discussed the: (1) recent trends in Medicare beneficiary enrollment in health maintenance organizations (HMO); (2) obstacles that are preventing Medicare from realizing potential savings from HMO; (3) strategies that will enable Medicare to realize HMO savings; and (4) Health Care Financing Administration's (HCFA) efforts to test HMO payment reforms. GAO no...
Medicare and Medicaid Issue Area: Active Assignments
AA-95-15(3): Published: Jul 1, 1995. Publicly Released: Jul 1, 1995.
GAO provided information on its active assignments in the Medicare and Medicaid issue area as of July 6, 1995...
Medicare: Rapid Spending Growth Calls for More Prudent Purchasing
T-HEHS-95-193: Published: Jun 28, 1995. Publicly Released: Jun 28, 1995.
GAO discussed ways in which the Medicare program could avoid excessive or unnecessary spending. GAO noted that: (1) although private payers increasingly use aggressive cost-management strategies to control health care costs, the Health Care Financing Administration (HCFA) often finds it difficult to use these strategies to control health care costs, since payment policies are established at the co...
Medicare: Modern Management Strategies Needed to Curb Program Exploitation
T-HEHS-95-183: Published: Jun 15, 1995. Publicly Released: Jun 15, 1995.
GAO discussed ways for Medicare to avoid unnecessary payments stemming from waste, fraud, and abuse. GAO noted that: (1) Medicare's vulnerability to overpayments is due to higher than market rates for some services, inadequate fraud and abuse controls, superficial criteria for confirming provider authenticity, and weak enforcement efforts; (2) Medicare could have saved at least $3 billion over 5 y...
Medicare Managed Care: Program Growth Highlights Need to Fix HMO Payment Problems
T-HEHS-95-174: Published: May 24, 1995. Publicly Released: May 24, 1995.
Pursuant to a congressional request, GAO discussed Medicare's method of paying health maintenance organizations (HMO) for Medicare beneficiaries. GAO noted that: (1) currently, only 7 percent of Medicare beneficiaries are enrolled in HMO under the risk contract program, but HMO are rapidly increasing their enrollment of Medicare beneficiaries; (2) under the risk contract program, HMO are paid a fl...
Medicare: Opportunities Are Available to Apply Managed Care Strategies
T-HEHS-95-81: Published: Feb 10, 1995. Publicly Released: Feb 10, 1995.
GAO discussed expanding managed care under the Medicare program, focusing on Medicare's health maintenance organization (HMO) payment policy, quality assurance standards, and dissemination of consumer information. GAO noted that: (1) Medicare is highly vulnerable to waste, fraud, abuse, and mismanagement; (2) the Health Care Financing Administration (HCFA) has made various regulatory and administr...
Medicare: High Spending Growth Calls for Aggressive Action
T-HEHS-95-75: Published: Feb 6, 1995. Publicly Released: Feb 6, 1995.
GAO discussed ways to control excessive and unnecessary spending in the Medicare program. GAO noted that: (1) the government faces many obstacles to bringing Medicare expenditures under control; (2) although broad-based payment system reforms have slowed aggregate spending, Medicare's spending growth rate remains high because inpatient and outpatient hospital, home health, skilled nursing, and phy...