Medical services rates (21 - 30 of 200 items)
Medicare Part B Imaging Services: Rapid Spending Growth and Shift to Physician Offices Indicate Need for CMS to Consider Additional Management Practices
GAO-08-452: Published: Jun 13, 2008. Publicly Released: Jul 14, 2008.
The Centers for Medicare & Medicaid Services (CMS)--an agency within the Department of Health and Human Services (HHS)--and the Congress, through the Deficit Reduction Act of 2005 (DRA), recently acted to constrain spending on imaging services, one of the fastest growing set of services under Medicare Part B, which covers physician and other outpatient services. GAO was asked to provide informatio...
Medicare Advantage Organizations: Actual Expenses and Profits Compared to Projections for 2005
GAO-08-827R: Published: Jun 24, 2008. Publicly Released: Jun 25, 2008.
Medicare Advantage (MA) organizations offer an alternative to the original Medicare fee-for-service (FFS) program. Payments to MA organizations are, in part, based on the revenue and expenditure projections MA organizations submit to the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--prior to the start of each contract year. Once Medicare payments are determi...
Medicare Physician Payments: Medicare and Private Payment Differences for Anesthesia Services
GAO-07-463: Published: Jul 27, 2007. Publicly Released: Aug 27, 2007.
In 2005 Medicare paid over $1.4 billion for anesthesia services. These services are generally provided by anesthesia practitioners, such as anesthesiologists and certified registered nurse anesthetists (CRNAs). A government-sponsored study found that Medicare payments for anesthesia services are lower than private payments. Congress is concerned that this difference may create regional discrepanci...
Medicare: CMS's Proposed Approach to Set Hospital Inpatient Payment Appears Promising
GAO-06-880: Published: Jul 28, 2006. Publicly Released: Jul 28, 2006.
Under Medicare's inpatient prospective payment system (IPPS), hospitals generally receive fixed payments for hospital stays based on diagnosis-related groups (DRG), a system that classifies stays by patient diagnosis and procedures. CMS is required to at least annually update DRG payments to address changes in the cost of inpatient care. CMS uses charge-based weights to update these payments. Cost...
Medicare Outpatient Payments: Rates for Certain Radioactive Sources Used in Brachytherapy Could Be Set Prospectively
GAO-06-635: Published: Jul 24, 2006. Publicly Released: Jul 24, 2006.
Generally, in paying for hospital outpatient procedures, Medicare makes prospectively set payments that are intended to cover the costs of all items and services delivered with the procedure. Medicare pays separately for some technologies that are too new to be represented in the claims data used to set rates. It also pays separately for certain technologies that are not new, such as radioactive s...
Medicare Part B Drugs: CMS Data Source for Setting Payments Is Practical but Concerns Remain
GAO-06-971T: Published: Jul 13, 2006. Publicly Released: Jul 13, 2006.
In 2005, the Centers for Medicare & Medicaid Services (CMS), as required by law, began paying for physician-administered Part B drugs using information on the drugs' average sales price (ASP). Subsequently, CMS selected ASP as the basis to pay for a subset of Part B drugs provided at hospital outpatient departments. To calculate ASP, CMS uses price data submitted quarterly by manufacturers. GAO wa...
Medicare: Comments on CMS Proposed 2006 Rates for Specified Covered Outpatient Drugs and Radiopharmaceuticals Used in Hospitals
GAO-06-17R: Published: Oct 31, 2005. Publicly Released: Oct 31, 2005.
On July 25, 2005, the Centers for Medicare & Medicaid Services (CMS) in the Department of Health and Human Services (HHS) published its notice of proposed rulemaking (NPRM) entitled "Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates." As part of these changes, CMS is proposing Medicare payment rates for certain hospital ou...
Federal Employees Health Benefits Program: Competition and Other Factors Linked to Wide Variation in Health Care Prices
GAO-05-856: Published: Aug 15, 2005. Publicly Released: Sep 14, 2005.
Congress is concerned about the health care spending burden facing the Federal Employees Health Benefits Program (FEHBP), the largest private health insurance program in the country. Health care spending per person varies geographically, and the underlying causes for the spending variation have not been fully explored. Understanding market forces and other factors that may influence health care sp...
Medicare: Radiopharmaceutical Purchase Prices for CMS Consideration in Hospital Outpatient Rate-Setting
GAO-05-733R: Published: Jul 14, 2005. Publicly Released: Jul 14, 2005.
Medicare pays hospitals for drugs and other pharmaceutical products that beneficiaries receive as part of their treatment in hospital outpatient departments. Specifically, the Centers for Medicare & Medicaid Services (CMS) in the Department of Health and Human Services (HHS) uses an outpatient prospective payment system (OPPS) to pay hospitals fixed, predetermined rates for services. These service...
Medicare: Drug Purchase Prices for CMS Consideration in Hospital Outpatient Rate-Setting
GAO-05-581R: Published: Jun 30, 2005. Publicly Released: Jun 30, 2005.
Medicare pays hospitals for drugs that beneficiaries receive as part of their treatment in hospital outpatient departments. Specifically, the Centers for Medicare & Medicaid Services (CMS) in the Department of Health and Human Services (HHS) uses an outpatient prospective payment system (OPPS) to pay hospitals fixed, predetermined rates for services. These services include drugs given to beneficia...