Medical services rates (71 - 79 of 79 items)
Medicare: Referring Physicians' Ownership of Laboratories and Imaging Centers
T-HRD-89-24: Published: Jun 1, 1989. Publicly Released: Jun 1, 1989.
GAO discussed physician referrals to clinical diagnostic laboratories and diagnostic imaging centers in Maryland and Pennsylvania, focusing on: (1) physician ownership of laboratories and imaging centers; (2) utilization rates and referral patterns of physician owners and nonowners; and (3) investment opportunities in facilities and the return gained on investments. GAO found that: (1) of the resp...
Medicare: Reasonableness of Health Maintenance Organization Payments Not Assured
HRD-89-41: Published: Mar 7, 1989. Publicly Released: Mar 7, 1989.
GAO reviewed Medicare health maintenance organizations' (HMO) adjusted community rates (ACR) process, focusing on HMO compliance with the Health Care Financing Administration's (HCFA) rate-setting guidelines and instructions.GAO reviewed ACR data from 1985 through 1987 for 19 HMO, and found that: (1) 11 HMO based their ACR estimates in part on cost and utilization data for other HMO, which HCFA re...
Medicare: Health Maintenance Organization Rate-Setting Issues
HRD-89-46: Published: Jan 31, 1989. Publicly Released: Jan 31, 1989.
Pursuant to a legislative requirement, GAO provided an overview of the data and methodology for computing Medicare monthly capitation payments to risk-contract health maintenance organizations (HMO).GAO planned to meet its statutory mandate by discussing selected issues relating to the implementation of the current rate-setting methodology, problems with various aspects of rate-setting, and possib...
Medicare and Medicaid: Updated Effects of Recent Legislation on Program and Beneficiary Costs
HRD-88-85: Published: Jul 26, 1988. Publicly Released: Aug 2, 1988.
Pursuant to a congressional request, GAO discussed the effects of legislation since 1980 on Medicare and Medicaid program costs and on beneficiary out-of-pocket costs.GAO did not attempt to quantify Medicare cost changes attributable to the major legislative changes because of the numerous interrelated factors affecting Medicare costs. GAO estimated that, if prior cost growth trends had continued,...
Medicare: Hospital Payment Rates Should Be Revised To Assure Reasonableness and Equity
T-HRD-88-9: Published: Mar 1, 1988. Publicly Released: Mar 1, 1988.
Pursuant to a congressional request, GAO discussed Medicare's Prospective Payment System (PPS) hospital rates. GAO noted that: (1) the original PPS rates were too high because they incorporated unaudited cost data, including unallowable costs and costs for unnecessary services; (2) subsequent annual updates and adjustments to rates have used estimated and incomplete data; (3) costs of services cov...
Medicaid: Early Problems in Implementing the Philadelphia HealthPASS Program
HRD-88-37: Published: Dec 22, 1987. Publicly Released: Dec 22, 1987.
In response to a congressional request, GAO reviewed Pennsylvania's progress and problems in implementing the Philadelphia Accessible Services System (HealthPASS), a contractor-operated program that manages and coordinates delivery of prepaid health care services to Medicaid recipients.GAO found that the contractor: (1) obtained a 2-year waiver of Medicaid regulations to administer HealthPASS as a...
Medicare: Payments to Radiologists, Anesthesiologists, and Pathologists
HRD-87-114BR: Published: Jul 20, 1987. Publicly Released: Jul 28, 1987.
Pursuant to a congressional request, GAO provided information on: (1) Medicare reimbursements for radiologists, anesthesiologists, and pathologists (RAP); and (2) the market structure for RAP services.GAO found that Medicare generally pays RAP on the same basis as other physicians, but limits reimbursement for: (1) inpatient radiology services because radiologists' capital costs for such services...
Defense Health Programs: Savings Available by Using Two Medicare Cost-Containment Techniques
HRD-86-115: Published: Aug 25, 1986. Publicly Released: Aug 25, 1986.
GAO reviewed the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) to determine whether it could better contain costs for professional services if it adopted two cost-containment techniques used in the Medicare program, including: (1) a fee schedule for outpatient laboratory services; and (2) an economic index for physician services.GAO analyzed five states' payment records a...
Implementation of Reimbursement Procedures for Outpatient Dialysis Treatments Under the End Stage Renal Disease Program of Medicare
120174: Apr 3, 1979
GAO completed a survey of the implementation of reimbursement procedures for outpatient dialysis treatments under the end stage renal disease program.At the time legislation was enacted authorizing Medicare end-stage renal disease program, few data were available on the cost of providing dialysis treatments. To have the program operational, interim rates were established. Medicare Bureau efforts t...