Medical services rates (11 - 20 of 79 items)
Medicare+Choice: Plan Withdrawals Indicate Difficulty of Providing Choice While Achieving Savings
HEHS-00-183: Published: Sep 7, 2000. Publicly Released: Sep 7, 2000.
Pursuant to a congressional request, GAO reviewed health care plans' withdrawal from the Medicare Choice program, focusing on the: (1) geographic distribution and the distribution among plans of enrollees affected by the recent plan withdrawals; (2) factors associated with plans that terminated or reduced their participation in the program; and (3) likely role of payment rates in affecting plans'...
Medicare+Choice: Payments Exceed Cost of Fee-for-Service Benefits, Adding Billions to Spending
HEHS-00-161: Published: Aug 23, 2000. Publicly Released: Aug 23, 2000.
Pursuant to a congressional request, GAO reviewed Medicare Choice program payment issues, focusing on: (1) whether program spending for Medicare Choice plan enrollees has exceeded what Medicare-covered care for these beneficiaries would have cost in the fee-for-service (FFS) Medicare program; and (2) the extent to which payments to individual plans differ from expected FFS costs.GAO noted that: (1...
Medicare: Refinements Should Continue to Improve Appropriateness of Provider Payments
T-HEHS-00-160: Published: Jul 19, 2000. Publicly Released: Jul 19, 2000.
Pursuant to a congressional request, GAO discussed the effects of recent Medicare payment reforms, focusing on the Balanced Budget Act of 1997 (BBA) payment reforms affecting home health agencies, skilled nursing facilities (SNF), and the health plans in Medicare's managed care program, known as Medicare Choice.GAO noted that: (1) the reactions by providers serving Medicare beneficiaries to BBA an...
Medicare Reform: Leading Proposals Lay Groundwork, While Design Decisions Lie Ahead
T-HEHS/AIMD-00-103: Published: Feb 24, 2000. Publicly Released: Feb 24, 2000.
Pursuant to a congressional request, GAO discussed two leading proposals on Medicare reform: (1) the President's Plan to Modernize and Strengthen Medicare for the 21st Century; and (2) S. 1895, entitled the Medicare Preservation and Improvement Act of 1999, which is commonly referred to as the Breax-Frist proposal.GAO noted that: (1) the elements of restructuring of Medicare as proposed by the Pre...
Medicare: Program Reform and Modernization Are Needed But Entail Considerable Challenges
T-HEHS/AIMD-00-77: Published: Feb 8, 2000. Publicly Released: Feb 8, 2000.
Pursuant to a congressional request, GAO discussed efforts to reform the administration, structure, and financing of the Medicare Program.GAO noted that: (1) in addition to its sizable financial imbalance, Medicare is outmoded from a programmatic perspective; (2) to address the need for an updated benefit package and adequate tools to moderate program spending, proposals have been advanced that in...
Medicare: Better Information Can Help Ensure That Refinements to BBA Reforms Lead to Appropriate Payments
T-HEHS-00-14: Published: Oct 1, 1999. Publicly Released: Oct 1, 1999.
Pursuant to a congressional request, GAO discussed the effects of the Balanced Budget Act of 1997 (BBA) on the Medicare program, focusing on the effects on three providers of post-acute care services--home health agencies (HHA), skilled nursing facilities (SNF), and providers of outpatient rehabilitation therapy--and on the health plans participating in the Medicare Choice program.GAO noted that:...
Skilled Nursing Facilities: Medicare Payments Need to Better Account for Nontherapy Ancillary Cost Variation
HEHS-99-185: Published: Sep 30, 1999. Publicly Released: Sep 30, 1999.
Pursuant to a congressional request, GAO provided information on the Medicare payments for skilled nursing facilities' (SNF) services under the new prospective payment system (PPS), focusing on: (1) whether the SNF payment rates incorporate the costs of nontherapy ancillary services; and (2) an analysis of the PPS design and nontherapy ancillary cost variation to assess whether payments are distri...
Medicare+Choice: Reforms Have Reduced, but Likely Not Eliminated, Excess Plan Payments
HEHS-99-144: Published: Jun 18, 1999. Publicly Released: Jun 22, 1999.
Pursuant to a congressional request, GAO reviewed concerns surrounding the Balanced Budget Act's (BBA) health plan payment changes, focusing on: (1) the extent to which health plans provide additional benefits and whether they could continue to provide additional benefits if payments were reduced; (2) the evidence regarding managed care's effect on Medicare spending; and (3) whether BBA provisions...
VA Health Care: Third-Party Charges Based on Sound Methodology; Implementation Challenges Remain
HEHS-99-124: Published: Jun 11, 1999. Publicly Released: Jun 11, 1999.
Pursuant to a legislative requirement, GAO provided information on the Department of Veterans Affairs' (VA) third party charges, focusing on: (1) the soundness of VA's methodology for setting reasonable charges for inpatient facility, skilled nursing, outpatient facility, physician, and nonphysician services; and (2) potential effects of the new charge-based system on VA, insurers, and veterans.GA...
Medicare+Choice: Impact of 1997 Balanced Budget Act Payment Reforms on Beneficiaries and Plans
T-HEHS-99-137: Published: Jun 9, 1999. Publicly Released: Jun 9, 1999.
Pursuant to a congressional request, GAO discussed on the impact of payment reforms in the Balanced Budget Act of 1997 (BBA) on the Medicare Choice program.GAO noted that: (1) the net effect of BBA payment revisions has been to reduce but not fully eliminate excess payments to health plans; (2) some of the provisions, such as the reduced annual updates, have already been implemented, while others,...