Health care services (41 - 50 of 1,007 items)
International Classification of Diseases: CMS Has Updated Systems and Supported Stakeholders' Efforts to Use New Codes
GAO-15-789: Published: Sep 17, 2015. Publicly Released: Sep 17, 2015.
The Centers for Medicare & Medicaid Services (CMS) has finished updating its systems with the changes it determined were needed to process the new International Classification of Diseases codes (ICD-10) on Medicare fee-for-service claims. In 2007, CMS began taking steps to identify components of its systems that needed to be changed to update the ICD codes from version 9 to 10. CMS began making th...
Defense Health Care Reform: Actions Needed to Help Ensure Defense Health Agency Maintains Implementation Progress
GAO-15-759: Published: Sep 10, 2015. Publicly Released: Sep 10, 2015.
Nearly 2 years after the creation of the Defense Health Agency (DHA), the Department of Defense (DOD) has made progress toward completing its implementation process, but has not addressed issues related to GAO's past recommendations regarding personnel requirements, an approach to cost savings, and performance measures.Personnel - The DHA has initiated the process of assessing personnel requiremen...
Private Health Insurance: The Range of Premiums and Plan Availability for Individuals in 2014 and 2015
GAO-15-687: Published: Aug 10, 2015. Publicly Released: Sep 9, 2015.
As of 2014, key provisions of the Patient Protection and Affordable Care Act (PPACA) resulted in the establishment of health insurance exchanges in each state and changed how insurers determined health insurance premiums. Individual market consumers generally had access to more health plans in 2015 compared to 2014, and in both years the lowest-cost plans were available through exchanges in most o...
Behavioral Health: Options for Low-Income Adults to Receive Treatment in Selected States
GAO-15-449: Published: Jun 19, 2015. Publicly Released: Jul 20, 2015.
Nationwide, estimates using 2008-2013 data indicated that approximately 17 percent of low-income, uninsured adults (3 million) had a behavioral health condition, defined as a serious mental illness, a substance use condition, or both. Underlying these national estimates is considerable variation at the state level.Estimated Percentage of Low-Income, Uninsured Adults with Behavioral Health Conditio...
Medicaid: Service Utilization Patterns for Beneficiaries in Managed Care
GAO-15-481: Published: May 29, 2015. Publicly Released: Jun 29, 2015.
Based on GAO's analysis of 2010 encounter data reported by 19 states, the number of professional services utilized by adult beneficiaries ranged from about 13 to 55. For children, the number of professional services utilized per beneficiary was lower, ranging from about 6 to 16 among the 19 states. Professional services included four categories of services: (1) evaluation and management (E/M) serv...
VA Health Care: Improvements Needed to the Monitoring of Antidepressant Use for Major Depressive Disorder and the Accuracy of Suicide Data
GAO-15-648T: Published: Jun 10, 2015. Publicly Released: Jun 10, 2015.
Department of Veterans Affairs (VA) policy states that antidepressant treatment must be consistent with VA's current clinical practice guideline (CPG) for major depressive disorder (MDD); however, GAO's recent review of 30 veterans' medical records found that most contained deviations. For example, although the CPG recommends that veterans' depressive symptoms be assessed at 4-6 weeks after initia...
Medicare Administrative Contractors: CMS Should Consider Whether Alternative Approaches Could Enhance Contractor Performance
GAO-15-372: Published: Apr 30, 2015. Publicly Released: Jun 1, 2015.
As of February 2015, 16 Medicare Administrative Contractors (MAC) administered claims submitted by Medicare providers and suppliers. Twelve were A/B MACs that administered Medicare Part A and Part B claims for inpatient hospital care, outpatient physician and hospital services, and home health and hospice care, among other services, in specific jurisdictions. Four other MACs administered claims fo...
VA Health Care: Actions Needed to Improve Monitoring and Oversight of Non-VA and Contract Care
GAO-15-654T: Published: Jun 1, 2015. Publicly Released: Jun 1, 2015.
GAO's recent work has found significant weaknesses in the Department of Veterans Affairs' (VA) monitoring and oversight of its Non-VA Medical Care Program. Through this program, care is provided to veterans by non-VA providers in non-VA facilities. As GAO reported in May 2013, VA did not collect data on wait times veterans face in obtaining care from non-VA providers. Having data on wait times for...
Medicare: Results from the First Two Years of the Pioneer Accountable Care Organization Model
GAO-15-401: Published: Apr 22, 2015. Publicly Released: May 22, 2015.
Health care providers and suppliers voluntarily form accountable care organizations (ACO) to provide coordinated care to patients with the goal of reducing spending while improving quality. Within the Centers for Medicare & Medicaid Services (CMS), the Center for Medicare & Medicaid Innovation (CMMI) began testing the Pioneer ACO Model in 2012. Under this model, ACOs can earn additional Medicare p...
Veterans Affairs Health Care: Addition to GAO's High Risk List and Actions Needed for Removal
GAO-15-580T: Published: Apr 29, 2015. Publicly Released: Apr 29, 2015.
To determine which federal government programs and functions should be designated high risk, GAO considers a number of factors. For example, it assesses whether the risk involves public health or safety, service delivery, national security, national defense, economic growth, or privacy or citizens' rights, or whether the risk could result in significantly impaired service, program failure, injury...