Health insurance (51 - 60 of 335 items)
Medicare Preventive Services: Most Beneficiaries Receive Some but Not All Recommended Services
GAO-04-1004T: Published: Sep 21, 2004. Publicly Released: Sep 21, 2004.
Preventive care depends on identifying health risks and on taking steps to control these risks. In contrast, Medicare, the federal health program insuring almost 35 million beneficiaries age 65 or older, was established largely to help pay beneficiaries' health care costs when they became ill or injured. Congress has broadened Medicare coverage over time to include specific preventive services, su...
Medicare Secondary Payer: Improvements Needed to Enhance Debt Recovery Process
GAO-04-783: Published: Aug 20, 2004. Publicly Released: Sep 20, 2004.
Last year, employer-sponsored group health plans (EGHP) were responsible for most of the nearly $183 million in outstanding Medicare secondary payer (MSP) debt. MSP debts arise when Medicare inadvertently pays for services that are subsequently determined to be the financial responsibility of another. The Centers for Medicare & Medicaid Services (CMS) administers Medicare with the assistance of ab...
Medicare: Information Needed to Assess Adequacy of Rate-Setting Methodology for Payments for Hospital Outpatient Services
GAO-04-772: Published: Sep 17, 2004. Publicly Released: Sep 17, 2004.
Under the Medicare hospital outpatient prospective payment system (OPPS), hospitals receive a temporary additional payment for certain new drugs and devices while data on their costs are collected. In 2003, these payments expired for the first time for many drugs and devices. To incorporate these items into OPPS, the Centers for Medicare & Medicaid Services (CMS) used its rate-setting methodology...
Milwaukee Health Care Spending Compared to Other Metropolitan Areas: Geographic Variation in Spending for Enrollees in the Federal Employees Health Benefits Program
GAO-04-1000R: Published: Aug 18, 2004. Publicly Released: Aug 23, 2004.
Health care spending varies across the country due to differences in the use and price of health care services. Understanding the reasons for utilization and price variation may contribute to developing methods to control health care spending. This report provides preliminary results from our work on geographic variations in health care spending and prices. Congress asked us to examine geographic...
Medicare: CMS Needs Additional Authority to Adequately Oversee Patient Safety in Hospitals
GAO-04-850: Published: Jul 20, 2004. Publicly Released: Jul 20, 2004.
Hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are considered in compliance with Medicare participation requirements. GAO examined the extent to which JCAHO's pre-2004 hospital accreditation process identified hospitals not complying with Medicare requirements, the potential of JCAHO's new process for improving the detection of deficiencies in Med...
Medicare Dialysis Facilities: Beneficiary Access Stable and Problems in Payment System Being Addressed
GAO-04-450: Published: Jun 25, 2004. Publicly Released: Jun 25, 2004.
Medicare covers about 90 percent of patients with end-stage renal disease (ESRD), the permanent loss of kidney function. Most ESRD patients receive regular hemodialysis treatments, a process that removes toxins from the blood, at a dialysis facility. A small percentage dialyzes-at home. From 1991 through 2001, the ESRD patient population more than doubled, from about 201,000 to 406,000. As the nee...
Medicare: CMS Did Not Control Rising Power Wheelchair Spending
GAO-04-716T: Published: Apr 28, 2004. Publicly Released: Apr 28, 2004.
Medicare spending for power wheelchairs, one of the program's most expensive items of durable medical equipment (DME), rose 450 percent from 1999 through 2003, while overall Medicare spending rose by about 11 percent for the same period, according to the Centers for Medicare & Medicaid Services (CMS). This spending growth has raised concerns that Medicare made improper payments and has payment rat...
Medicare Savings Programs: Results of Social Security Administration's 2002 Outreach to Low-Income Beneficiaries
GAO-04-363: Published: Mar 26, 2004. Publicly Released: Mar 26, 2004.
To assist low-income beneficiaries with their share of premiums and other out-of-pocket costs associated with Medicare, Congress has created four Medicare savings programs. Historic low enrollment in these programs has been attributed to several factors, including lack of awareness about the programs, and cumbersome eligibility determination and enrollment processes through state Medicaid programs...
Medicare: Payment Changes Are Needed for Assistants-at-Surgery
GAO-04-97: Published: Jan 13, 2004. Publicly Released: Jan 13, 2004.
Medicare pays for assistant-atsurgery services under both the hospital inpatient prospective payment system and the physician fee schedule. Payments under the physician fee schedule are limited to a few health professions. In 2001, Congress directed GAO to report on the potential impact on the Medicare program of allowing physician fee schedule payments to Certified Registered Nurse First Assistan...
Medicare: Divided Authority for Policies on Coverage of Procedures and Devices Results in Inequities
GAO-03-175: Published: Apr 11, 2003. Publicly Released: May 12, 2003.
Critical choices on whether new technology will be covered for Medicare's 40 million beneficiaries are made nationally by the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--or locally by contractors that process and pay claims. GAO was asked to review the degree to which new procedures and devices are incorporated into Medicare, the effect of Medicare coverag...