Medical expense claims (51 - 60 of 64 items)
Medicare: Need for Consistent National Payment Policy for Special Anesthesia Services
HRD-91-23: Published: Mar 13, 1991. Publicly Released: Mar 13, 1991.
Pursuant to a legislative requirement, GAO reviewed Medicare's anesthesia payment system, focusing on the: (1) extent to which carriers used modifier units to allow extra payments for factors such as patient age, physical status, or unusual risk circumstances; and (2) appropriateness of such payments.GAO found that: (1) before 1989, Medicare payments for anesthesia modifiers and special monitoring...
Medicare: Employer Insurance Primary Payer for 11 Percent of Disabled Beneficiaries
HRD-90-79: Published: May 10, 1990. Publicly Released: May 10, 1990.
Pursuant to a legislative requirement, GAO determined the number of beneficiaries for whom Medicare became the secondary payer because of their own or a family member's employment.GAO found that during 1988, the Omnibus Budget Reconciliation Act of 1986 made Medicare the secondary payer for 340,000 disabled beneficiaries, which consisted of: (1) 214,000 persons that had health insurance coverage t...
Military Health Care: Recovery of Medical Costs From Liable Third Parties Can Be Improved
NSIAD-90-49: Published: Apr 19, 1990. Publicly Released: May 4, 1990.
Pursuant to a congressional request, GAO evaluated the effectiveness of the Department of Defense's (DOD) medical cost recovery in third-party liability cases.GAO found that: (1) 8 of the 13 Army and Navy medical facilities it studied did not identify and report more than half of the potential third-party liability cases because they lacked standard procedures; (2) some Air Force and Navy installa...
VA Health Care: Better Procedures Needed to Maximize Collections From Health Insurers
HRD-90-64: Published: Apr 6, 1990. Publicly Released: May 4, 1990.
Pursuant to a congressional request, GAO reviewed whether the Department of Veterans Affairs (VA): (1) collections from health insurers exceeded health care costs; and (2) had effective procedures to identify insured veterans and bill insurers and collect amounts owed.GAO found that: (1) VA collected only about one-third of the health care costs for medical services it provided to insured veterans...
Medicare Claims: HCFA Proposal To Establish an Administrative Law Judge Unit
HRD-88-84BR: Published: Apr 20, 1988. Publicly Released: Apr 20, 1988.
Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) proposed plan to establish its own hearings and appeals unit to handle Medicare hearings, at an estimated cost of $15 million.GAO found that, under the proposed plan, HCFA: (1) would use 42 administrative law judges (ALJ) compared to the 666 the Social Security Administration (SSA) currently uses;...
Medicare: Contractor Services to Beneficiaries and Providers
HRD-88-76BR: Published: Mar 16, 1988. Publicly Released: Apr 19, 1988.
GAO assessed the level of beneficiary and provider satisfaction with the Health Care Financing Administration's (HCFA) Medicare services program, specifically: (1) claims processing timeliness and accuracy; (2) responsiveness to beneficiary and provider inquiries; and (3) the processes available to beneficiaries and providers to dispute decisions about reimbursement and program coverage.GAO found...
CHAMPUS Has Improved Its Methods for Procuring and Monitoring Fiscal Intermediary Services To Process Medical Claims
HRD-85-56: Published: Aug 23, 1985. Publicly Released: Sep 23, 1985.
Pursuant to a congressional request, GAO reviewed: (1) The Department of Defense's Office of Civilian Health and Medical Program of the Uniformed Services' use of contracting procedures to obtain fiscal intermediary services for processing health insurance claims to determine whether they were suited to ensuring high-quality performance at the lowest possible cost to the government; and (2) the pe...
Electronic Data Systems Federal Corporation's Performance as a Medicare Contractor in Illinois
112192: Apr 28, 1980
The Medicare program has three ongoing experiments which are testing competitive fixed-price procurement. Medicare contracts with carriers which process claims for physicians and other practitioner services (part B) and intermediaries which process claims for facility services (part A) have traditionally been on a cost reimbursement basis. In 1978, the Health Care Financing Administration (HCFA) u...
Stronger Management Needed To Improve Employee Organization Health Plans' Payment Practices
HRD-79-87: Published: Sep 7, 1979. Publicly Released: Sep 17, 1979.
The Office of Personnel Management (OPM) has not done an effective job of guiding and overseeing the Employee Organization Plans participating in the Federal Employees Health Benefits program. OPM has allowed the plans to make claim payments without determining whether the claims represented sound comprehensive systems to determine the reasonableness of charges as the contracts require.The Plans h...
More Can Be Done To Achieve Greater Efficiency in Contracting for Medicare Claims Processing
HRD-79-76: Published: Jun 29, 1979. Publicly Released: Jun 29, 1979.
Most Medicare benefits are administered by the Department of Health, Education, and Welfare (HEW) through contracts with private insurance companies called intermediaries, which pay bills for services provided by health care facilities, and other contractors called carriers, which pay claims for services from doctors and suppliers. These contracts have been on a cost reimbursable basis, with neith...