Managed health care (61 - 70 of 203 items)
Medicare Financial Management: Significant Progress Made to Enhance Financial Accountability
GAO-03-151R: Published: Oct 31, 2002. Publicly Released: Oct 31, 2002.
Medicare provided health care coverage to 40 million people age 65 and over and to qualifying disabled persons at a cost of $240 billion in fiscal year 2001. In 1990, GAO designated the program as "high risk" for fraud and abuse because of its vast size, complex structure, and program management weaknesses. GAO issued two reports in 2000 that discussed weaknesses in the Centers for Medicare and Me...
Medicare Physician Payments: Medical Settings and Safety of Endoscopic Procedures
GAO-03-179: Published: Oct 18, 2002. Publicly Released: Oct 18, 2002.
Every year millions of Americans covered by Medicare undergo endoscopic medical procedures in a variety of health care settings ranging from physicians' offices to hospitals. These invasive procedures call for the use of a lighted, flexible instrument and are used for screening and treating disease. Although some of these procedures can be performed while the patient is fully awake, most require s...
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: 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: Use of Preventive Services is Growing but Varies Widely
GAO-02-777T: Published: May 23, 2002. Publicly Released: May 23, 2002.
Preventive health care services can extend lives and promote the well being of the nation's seniors. Medicare now covers 10 preventive services--three types of immunizations and seven types of screenings--and legislation has been introduced to cover additional services. However, not all beneficiaries avail themselves of Medicare's preventive services. Some may simply choose not to use them, but ot...
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...
Medicare Home Health Care: Payments to Home Health Agencies Are Considerably Higher than Costs
GAO-02-663: Published: May 6, 2002. Publicly Released: May 6, 2002.
The Balanced Budget Act of 1997 significantly changed Medicare's home health care payments to home health agencies (HHAs). Under a prospective payment system (PPS), HHAs are paid a fixed amount, adjusted for beneficiary care needs, for providing up to 60 days of care---termed a "home health episode." The act also imposed new interim payment limits to moderate spending until the PPS could be imple...
Medicare Home Health: Clarifying the Homebound Definition Is Likely to Have Little Effect on Costs and Access
GAO-02-555R: Published: Apr 26, 2002. Publicly Released: Apr 26, 2002.
Medicare's home health benefit provides skilled nursing and other services to beneficiaries who are homebound. The Department of Health and Human Services (HHS) had a long-standing policy that beneficiaries who regularly attend adult day care were not considered homebound, particularly if the purpose of attending was to receive nonmedical or custodial care. In 2000, Congress indicated that Medicar...
Medicare: Financial Outlook Poses Challenges for Sustaining Program and Adding Drug Coverage
GAO-02-643T: Published: Apr 17, 2002. Publicly Released: Apr 17, 2002.
The lack of outpatient prescription drug coverage may leave Medicare's most vulnerable beneficiaries with high out-of-pocket costs. Recent estimates suggest that, at any given time, more than a third of Medicare beneficiaries lack prescription drug coverage. The rest have some coverage through various sources--most commonly employer-sponsored health plans. Recent evidence indicates that this cover...
Medigap: Current Polices Contain Coverage Gaps, Undermine Cost Control Incentives
GAO-02-533T: Published: Mar 14, 2002. Publicly Released: Mar 14, 2002.
Medicare provides valuable and extensive health care coverage for 40 million elderly and disabled beneficiaries. Nevertheless, significant gaps leave some beneficiaries vulnerable to sizeable out-of-pocket expenses. Medicare provides no limit on out-of-pocket spending and no coverage for most outpatient prescription drugs. Most beneficiaries have supplemental coverage that helps to fill Medicare c...