Health services administration (71 - 80 of 118 items)
Medicare Managed Care: HCFA Missing Opportunities to Provide Consumer Information
T-HEHS-97-109: Published: Apr 10, 1997. Publicly Released: Apr 10, 1997.
GAO discussed: (1) Medicare beneficiaries' need for comparative information on health maintenance organizations (HMO); and (2) steps the Health Care Financing Administration (HCFA) could take to meet that need promptly.GAO noted that: (1) HCFA does not distribute to beneficiaries comparative consumer guides such as those the federal government and many employer-based health insurance programs rout...
Rural Health Clinics: Rising Program Expenditures Not Focused on Improving Care in Isolated Areas
T-HEHS-97-65: Published: Feb 13, 1997. Publicly Released: Feb 13, 1997.
GAO discussed its recent report on the Rural Health Clinic (RHC) program, one of the few federal programs that addresses underservice in small communities that do not have a traditional health care system in place.GAO noted that: (1) the RHC program needs to be refocused; (2) while some clinics clearly meet the program's initial focus of serving Medicare and Medicaid populations having difficulty...
Skilled Nursing Facilities: Approval Process for Certain Services May Result in Higher Medicare Costs
HEHS-97-18: Published: Dec 20, 1996. Publicly Released: Jan 22, 1997.
Pursuant to a congressional request, GAO reviewed: (1) the growth of skilled nursing facility (SNF) costs and SNF use in relation to hospital use; (2) the characteristics of Medicare SNF patients and the types of services they receive in SNFs being paid higher than normal amounts compared to other SNFs, as well as whether patients in such facilities receive appropriate care; and (3) whether the He...
Health Services Quality and Public Health Issue Area--Active Assignments
AA-97-14(1): Published: Jan 2, 1997. Publicly Released: Jan 2, 1997.
GAO provided information on its active assignments in the Health Services Quality and Public Health issue area as of January 2, 1997...
Medicaid: States' Efforts to Educate and Enroll Beneficiaries in Managed Care
HEHS-96-184: Published: Sep 17, 1996. Publicly Released: Oct 29, 1996.
Pursuant to a congressional request, GAO provided information on state efforts to enroll Medicaid beneficiaries in managed care, focusing on: (1) the role of managed care organizations (MCO) in marketing and expanding managed care participation; (2) the types of marketing and enrollment abuses that have occurred and states' efforts to curb these abuses and ensure that beneficiaries are informed ab...
Medicare Drug and Nutrient Prices
HEHS-97-22R: Published: Oct 11, 1996. Publicly Released: Oct 11, 1996.
Pursuant to a congressional request, GAO reviewed the reasonableness of Medicare payments for outpatient drugs and liquid nutrients. GAO noted that: (1) the Health Care Financing Administration's (HCFA) policy reimburses outpatient drugs based on estimated acquisition costs or on the median, if applicable, of national average wholesale prices (AWP) for all generic sources; (2) Medicare contractors...
Medicare: Private-Sector and Federal Efforts to Assess Health Care Quality
T-HEHS-96-215: Published: Sep 19, 1996. Publicly Released: Sep 19, 1996.
GAO discussed the Health Care Financing Administration's (HCFA) efforts to provide health care quality information to Medicare beneficiaries joining health maintenance organizations (HMO). GAO noted that: (1) corporate purchasers use accreditation and performance measurement monitoring to ensure that HMO furnish quality health care; (2) HCFA is starting to use similar methods to ensure HMO quality...
HCFA: Medicare Program--Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 1997 Rates
OGC-96-41: Published: Sep 13, 1996. Publicly Released: Sep 13, 1996.
Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) new rule on changes to the Medicare Program's hospital inpatient prospective payment systems and fiscal year 1997 rates. GAO found that: (1) the rule would adjust the classifications and weighting factors for diagnosis related groups, update the wage index associated with hospital operating costs,...
Fraud and Abuse: Providers Excluded From Medicaid Continue to Participate in Federal Health Programs
T-HEHS-96-205: Published: Sep 5, 1996. Publicly Released: Sep 5, 1996.
GAO discussed whether the Department of Health and Human Services' (HHS) Office of Inspector General's (OIG) process for removing fraudulent health care providers from all federal health programs. GAO noted that: (1) weaknesses within HHS OIG allow sanctioned health care providers to remain in federal health care programs; (2) these weaknesses include lengthy delays in the OIG decision-making proc...
Health Financing and Systems Issue Area Plan--Fiscal Years 1997-99
IAP-96-26: Published: Sep 1, 1996. Publicly Released: Sep 1, 1996.
GAO provided information on its Health Financing and Systems issue area plan for fiscal years 1997 to 1999.GAO plans to: (1) review the Health Care Financing Administration's efforts to collect payments from other insurers in the Medicare Secondary Payer program; (2) review states' ability to monitor managed care plans' financial solvency and administrative costs; (3) review managed care programs...