Health care costs (71 - 80 of 286 items)
Ambulance Services: Medicare Payments Can Be Better Targeted to Trips in Less Densely Populated Rural Areas
GAO-03-986: Published: Sep 19, 2003. Publicly Released: Sep 19, 2003.
The Centers for Medicare & Medicaid Services (CMS) recently implemented a Medicare ambulance fee schedule in which providers are paid a base payment per trip plus a mileage payment. An adjustment is made to the mileage rate for rural trips to account for higher costs. CMS has stated that this rural adjustment may not sufficiently target providers serving sparsely populated rural areas. The Medicar...
Medicare: Modest Eligibility Expansion for Critical Access Hospital Program Should Be Considered
GAO-03-948: Published: Sep 19, 2003. Publicly Released: Sep 19, 2003.
Critical Access Hospitals (CAHs) are small rural hospitals that receive payment for their reasonable costs of providing inpatient and outpatient services to Medicare beneficiaries, rather than being paid fixed amounts under Medicare's prospective payment systems. Between fiscal years 1997 and 2002, 681 hospitals have become CAHs. In the Medicare, Medicaid and SCHIP Benefits Improvement and Protect...
Medicare Home Health Payment: Nonroutine Medical Supply Data Needed to Assess Payment Adjustments
GAO-03-878: Published: Aug 15, 2003. Publicly Released: Aug 15, 2003.
Under Medicare's prospective payment system (PPS), home health agencies receive a single payment, adjusted to reflect the care needs of different types of patients, for providing up to 60 days of home health care. Some home health industry representatives have suggested that certain nonroutine medical supplies (such as wound-care dressings) should be excluded from this payment and reimbursed separ...
Medicare: Payment for Blood Clotting Factor Exceeds Providers' Acquisition Cost
GAO-03-184: Published: Jan 10, 2003. Publicly Released: Feb 11, 2003.
In 2001, Medicare's outpatient expenditures for blood clotting factor used to treat the estimated 1,100 beneficiaries with hemophilia totaled about $105 million, or more than 2 percent of total Medicare spending on outpatient drugs. Earlier work by GAO indicated that Medicare's payment for certain outpatient drugs is substantially higher than providers' acquisition costs. Concerns have been raised...
Skilled Nursing Facilities: Available Data Show Average Nursing Staff Time Changed Little after Medicare Payment Increase
GAO-03-176: Published: Nov 13, 2002. Publicly Released: Nov 13, 2002.
The nation's 15,000 skilled nursing facilities (SNF) play an essential role in our health care system, providing Medicare-covered skilled nursing and rehabilitative care each year for 1.4 million Medicare patients who have recently been discharged from acute care hospitals. In recent years, many analysts and other observers, including members of Congress, have expressed concern about the level of...
Medicare Hospital Payments: Refinements Needed to Better Account for Geographic Differences in Wages
GAO-02-963: Published: Sep 30, 2002. Publicly Released: Sep 30, 2002.
The Medicare program's prospective payment system (PPS) for inpatient hospital services provides incentives for hospitals to operate efficiently by paying them a predetermined, fixed amount for each inpatient hospital stay regardless of the actual costs incurred in providing the care. Although the fixed amount is based on national average costs, actual per stay payments vary widely across hospital...
Medicare Home Health Agencies: Weaknesses in Federal and State Oversight Mask Potential Quality Issues
GAO-02-382: Published: Jul 19, 2002. Publicly Released: Jul 19, 2002.
The 6,900 Home Health Agencies (HHAs) that serve Medicare beneficiaries must meet federal requirements, known as conditions of participation (COP), to ensure that they have the appropriate staff, are following the plan of care specified by a physician, maintain medical records to document the care provided, and periodically reassess each patient's condition. Although nationwide surveys done at HHA...
Medicare: Recent CMS Reforms Address Carrier Scrutiny of Physicians' Claims for Payment
GAO-02-693: Published: May 28, 2002. Publicly Released: May 28, 2002.
In 1990, GAO designated the Medicare program to be at high-risk for waste, fraud, and abuse. More than a decade later, Medicare remains on GAO's high-risk list. This report examines Medicare's claims review process, which is designed to detect improper billing or payments. GAO found that most physicians who bill Medicare are largely unaffected by carriers' medical reviews, with 90 percent of physi...
Medicare: Using Education and Claims Scrutiny to Minimize Physician Billing Errors
GAO-02-778T: Published: May 28, 2002. Publicly Released: May 28, 2002.
In its audit for year 2001, the Department of Health and Human Services' Office of Inspector General found that $12.1 billion was improperly paid to Medicare providers. GAO's February report (GAO-02-249) showed that physicians often do not receive complete, accurate, clear, or timely guidance on Medicare billing and payment policies. At the carriers studied, GAO found significant shortcomings in p...
Medicare: Orthotics Ruling Has Implications for Beneficiary Access and Federal and State Costs
GAO-02-330: Published: May 22, 2002. Publicly Released: May 22, 2002.
In the late 1980s and early 1990s, the Health Care Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), became concerned that some suppliers were improperly billing Medicare for items that attach to wheelchairs and other equipment. Some suppliers were billing for such items using codes for orthodic devices, including arm, back, and neck braces that prov...