Managed health care (51 - 60 of 203 items)
Medicare: Most Beneficiaries Receive Some but Not All Recommended Preventive Services
GAO-03-958: Published: Sep 8, 2003. Publicly Released: Oct 8, 2003.
Medicare, the federal health program insuring almost 35 million beneficiaries age 65 and older, covers certain preventive services, such as flu shots and mammograms. Most beneficiaries receive care through Medicare's fee-for-service program, under which they generally receive these services as part of visits to the doctor for specific illnesses or conditions. Other beneficiaries receive services u...
Medicare: Discrepancy in Hospital Outpatient Prospective Payment System Methodology Leads to Inaccurate Beneficiary Copayments and Medicate Payments
GAO-04-103R: Published: Oct 6, 2003. Publicly Released: Oct 6, 2003.
Under the Medicare hospital outpatient prospective payment system (OPPS), beneficiaries can be responsible for paying 50 percent or more of the total payment for outpatient services they receive in hospitals. The Balanced Budget Act of 1997 (BBA) introduced a mechanism to gradually decrease beneficiary cost sharing to 20 percent of the payment rate for each hospital outpatient service. The Centers...
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: 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...
Medicare: Financial Challenges and Considerations for Reform
GAO-03-577T: Published: Apr 10, 2003. Publicly Released: Apr 10, 2003.
We are pleased to be here today as Congress examines Medicare's financial health and consider the budgetary and economic challenges presented by an aging society. The Comptroller General has been particularly attentive to the sustainability challenges faced by the nation's two largest entitlement programs--Medicare and Social Security--for more than a decade since he served as a public trustee for...
Medicare: Observations on Program Sustainability and Strategies to Control Spending on Any Proposed Drug Benefit
GAO-03-650T: Published: Apr 9, 2003. Publicly Released: Apr 9, 2003.
The House Committee on Ways and Means is holding a hearing on modernizing Medicare and integrating prescription drugs into the program. There are growing concerns about gaps in the Medicare program, most notably the lack of outpatient prescription drug coverage, which may leave Medicare's most vulnerable beneficiaries with high out-of-pocket costs. At the same time, Medicare already faces a huge p...
Defense Health Care: Oversight of the Adequacy of TRICARE's Civilian Provider Network Has Weaknesses
GAO-03-592T: Published: Mar 27, 2003. Publicly Released: Mar 27, 2003.
During 2002, in testimony to the House Armed Services Committee, Subcommittee on Personnel, beneficiary groups described problems with access to care from TRICARE's civilian providers, and providers testified about their dissatisfaction with the TRICARE program, specifying low reimbursement rates and administrative burdens. The Bob Stump National Defense Authorization Act of 2003 required that GAO...
Medicare Provider Enrollment: Opportunities to Enhance Program Integrity Efforts
GAO-03-185: Published: Mar 17, 2003. Publicly Released: Mar 17, 2003.
Staffing companies that contract with physicians to staff hospital departments--including emergency departments--are not permitted to bill Medicare. In the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Congress directed GAO to assess the program integrity implications of enrolling these companies and allowing them to bill Medicare. GAO reviewed about 2.8 million em...
Medicare+Choice: Selected Program Requirements and Other Entities' Standards for HMOs
GAO-03-180: Published: Oct 31, 2002. Publicly Released: Dec 2, 2002.
Since the early 1980s, health maintenance organizations (HMO) have entered into risk-based contracts with Medicare and offered beneficiaries an alternative to the traditional fee-for-service (FFS) program. By 1997, 5.2 million Medicare beneficiaries were enrolled in an HMO. Although Medicare HMOs were available in most urban areas, they were often unavailable in rural areas. Medicare+Choice (M+C)...
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...