Health insurance cost control (31 - 40 of 267 items)
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...
Medicaid: HCFA and States Could Work Together to Better Ensure the Integrity of Providers
T-HEHS-00-159: Published: Jul 18, 2000. Publicly Released: Jul 18, 2000.
Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) efforts to better ensure the integrity of providers who bill the Medicaid program, focusing on: (1) why it is important to take steps to ensure that only honest providers bill federal health care programs; (2) what Medicare is doing to strengthen its provider enrollment process; (3) what states are...
Medicare Improper Payments: Challenges for Measuring Potential Fraud and Abuse Remain Despite Planned Enhancements
T-AIMD/OSI-00-251: Published: Jul 12, 2000. Publicly Released: Jul 12, 2000.
Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) efforts to improve the measurement of improper payments in the Medicare fee-for-service program.GAO noted that: (1) because it was not intended to include procedures designed specifically to identify all types of potential fraudulent and abusive activity, the current methodology does not provide an...
Medicare Payments: Use of Revised 'Inherent Reasonableness' Process Generally Appropriate
HEHS-00-79: Published: Jul 5, 2000. Publicly Released: Jul 5, 2000.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) and the Durable Medical Equipment Regional Carriers' (DMERC) actions to implement a final rule for processing Medicare payments, focusing on whether: (1) it was proper for HCFA to issue its inherent reasonableness regulations as an interim final rule, and whether HCFA is authorized to delegate respo...
Prescription Drugs: Adapting Private Sector Management Methods for a Medicare Benefit
T-HEHS-00-112: Published: May 11, 2000. Publicly Released: May 11, 2000.
Pursuant to a congressional request, GAO discussed the President's proposal to manage the high and rising costs of prescription drugs for the elderly by extending the private sector's prescription drug cost control techniques to the Medicare program.GAO noted that: (1) private insurers, managed care plans, and employers have tried to manage the high and rising costs of prescription drugs by adopti...
Medicare Reform: Issues Associated With General Revenue Financing
T-AIMD-00-126: Published: Mar 27, 2000. Publicly Released: Mar 27, 2000.
Pursuant to a congressional request, GAO discussed the use of general fund revenues as part of Social Security and Medicare reform, focusing on general revenue financing of the Medicare program.GAO noted that: (1) a consensus appears to be emerging that substantive financing and programmatic reforms are necessary to put Medicare on a sustainable footing for the future; (2) the current Medicare pro...
Prescription Drug Benefits: Applying Private Sector Management Methods to Medicare
T-HEHS-00-84: Published: Mar 22, 2000. Publicly Released: Mar 22, 2000.
Pursuant to a congressional request, GAO discussed issues related to a potential Medicare outpatient prescription drug benefit, focusing on: (1) the factors contributing to the rise in prescription drug spending and the impact of the rise in spending on Medicare beneficiaries; (2) the methods private insurers have developed to manage these rising costs; and (3) whether and how Medicare can adapt t...
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...
Prescription Drugs: Increasing Medicare Beneficiary Access and Related Implications
T-HEHS/AIMD-00-100: Published: Feb 16, 2000. Publicly Released: Feb 16, 2000.
Pursuant to a congressional request, GAO discussed options for increasing Medicare beneficiaries' access to prescription drugs, focusing on the: (1) factors contributing to the growth in prescription drug spending and efforts to control that growth; and (2) design and implementation issues to be considered regarding proposals to improve seniors' access to affordable prescription drugs.GAO noted th...