Medical expense claims (51 - 60 of 68 items)
Medicaid: Legislation Needed to Improve Collections From Private Insurers
HRD-91-25: Published: Nov 30, 1990. Publicly Released: Jan 8, 1991.
Pursuant to a congressional request, GAO reviewed problems that state Medicaid agencies experienced in collecting from third parties, focusing on out-of-state insurers and employee health benefit plans covered under the Employee Retirement Income Security Act of 1974 (ERISA).GAO found that: (1) states lacked jurisdiction over insurers that operated only incidentally in the state; (2) states' limit...
Medicare: Effects of Budget Reductions on Contractor Program Safeguard Activities
T-HRD-90-42: Published: Jun 14, 1990. Publicly Released: Jun 14, 1990.
GAO discussed its efforts to assess Medicare's vulnerability to waste, abuse, and mismanagement. GAO noted that Medicare contractors are: (1) cutting back on medical and utilization reviews of claims that are essential in detecting and preventing erroneous payments; (2) cutting back on audits of billions of dollars in costs claimed by institutional providers; and (3) unable to pursue hundreds of m...
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...
Medicare and Medicaid: More Information Exchange Could Improve Detection of Substandard Care
HRD-90-29: Published: Mar 7, 1990. Publicly Released: Mar 7, 1990.
GAO provided information on the Health Care Financing Administration's (HCFA) implementation of a recommendation that it develop guidelines to coordinate reporting on Medicaid and Medicare quality of care.GAO found that: (1) review entities, including insurance carriers and peer review organizations (PRO), did not routinely exchange information about problem physicians; (2) officials agreed that d...
Medicare: Withdrawing Eyeglass Coverage Recommended Following Cataract Surgery
HRD-90-31: Published: Feb 8, 1990. Publicly Released: Feb 8, 1990.
Pursuant to a congressional request, GAO examined the issues relating to Medicare reimbursement for cataract surgery.GAO found that: (1) Medicare regulations defined routine eye care and conventional eyeglasses as refractive corrections to improve the eye's focusing ability; (2) the Health Care Financing Administration (HCFA) considered conventional eyeglasses for those Medicare beneficiaries that...
Medicare: Improvements Needed in the Identification of Inappropriate Hospital Care
PEMD-90-7: Published: Dec 20, 1989. Publicly Released: Dec 20, 1989.
Pursuant to a congressional request, GAO examined both Medicare and private programs' approaches to assessing the appropriateness of hospital care and reducing the level of inappropriate hospital care.GAO found that: (1) both the Medicare and private programs conducted utilization review activities, typically involving nurses' examination of medical records and referral of suspected inappropriate...
Medicare: Incentives Needed to Assure Private Insurers Pay Before Medicare
HRD-89-19: Published: Nov 29, 1988. Publicly Released: Nov 29, 1988.
GAO reviewed the Health Care Financing Administration's (HCFA) and Medicare contractors' actions in response to GAO recommendations on erroneous payments of claims for which Medicare was not responsible. GAO focused on: (1) contractor incentives to improve billing procedures; and (2) controls to ensure that Medicare acted as secondary payer when insurance companies had primary payment responsibili...
Medicare: Improving Quality of Care Assessment and Assurance
PEMD-88-10: Published: May 2, 1988. Publicly Released: May 2, 1988.
In response to a congressional request, GAO reviewed: (1) the Health Care Financing Administration's (HCFA) medical review systems for measuring and monitoring Medicare quality of care; and (2) quality assessment research and evaluation within the Department of Health and Human Services (HHS).GAO found that: (1) there was no legislative requirement for nationally representative information on leve...
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;...
The Congress Should Consider Amending the Medicare Secondary Payer Provisions To Include Disability Beneficiaries
HRD-85-102: Published: Sep 30, 1985. Publicly Released: Sep 30, 1985.
Over the past several years, Congress has amended the Social Security Act to require that, when beneficiaries between the ages of 65 and 70 and those with end stage renal disease are covered under employer-sponsored group health insurance, private insurance pays for medical services before Medicare. Because of congressional actions to make Medicare the secondary payer for other beneficiaries cover...