Health care programs (11 - 20 of 104 items)
International Classification of Diseases: CMS's Efforts to Prepare for the New Version of the Disease and Procedure Codes
GAO-15-255: Published: Jan 28, 2015. Publicly Released: Feb 6, 2015.
The Centers for Medicare & Medicaid Services (CMS), within the Department of Health and Human Services (HHS), has undertaken a number of efforts to prepare for the October 1, 2015, transition to the 10th revision of the International Classification of Diseases (ICD-10) codes, which are used for documenting patient medical diagnoses and inpatient medical procedures. CMS has developed educational ma...
Compounded Drugs: Payment Practices Vary across Public Programs and Private Insurers, and Medicare Part B Policy Should Be Clarified
GAO-15-85: Published: Oct 10, 2014. Publicly Released: Nov 10, 2014.
Medicare, Medicaid, and private health insurers have varying payment practices for compounded drugs, depending upon whether compounded drugs and their ingredients can be identified on health insurance claims, and Medicare's Part B payment policy for these drugs is unclear.For drugs dispensed in pharmacy settings, claims contain sufficient information for public programs and private insurers to ide...
Medicare: Nurse Anesthetists Billed for Few Chronic Pain Procedures; Implementation of CMS Payment Policy Inconsistent
GAO-14-153: Published: Feb 7, 2014. Publicly Released: Mar 10, 2014.
From 2009 through 2012, certified registered nurse anesthetists (CRNA)—a type of advanced-practice nurse specializing in anesthesia care—billed Medicare fee-for-service (FFS) for a minimal share of selected chronic pain procedures, less than ½ of 1 percent of these procedures in each year. Physicians without board certification in pain medicine billed for the majority of selected procedures e...
Medicaid: Use of Claims Data for Analysis of Provider Payment Rates
GAO-14-56R: Published: Jan 6, 2014. Publicly Released: Jan 6, 2014.
Among the 9 states and 35 services examined, GAO found that all states varied Medicaid payments for at least some services. However, the states differed in the number of services for which they varied payments, in the factors that accounted for variation, and in the magnitude of the variation. Many of the states varied payment rates by at least one of the factors GAO was able to explore in detail:...
Clinical Data Registries: HHS Could Improve Medicare Quality and Efficiency through Key Requirements and Oversight
GAO-14-75: Published: Dec 16, 2013. Publicly Released: Dec 16, 2013.
Clinical data registries (CDR) have demonstrated a particular strength in assessing physician performance through their capacity to track and interpret trends in health care quality over time. Studies examining results reported by several long-established CDRs demonstrate the utility of CDR data sets for analyzing trends in both outcomes and treatments. CDR efforts to improve outcomes typically in...
Health Care Workforce: HRSA Action Needed to Publish Timely National Supply and Demand Projections
GAO-13-806: Published: Sep 30, 2013. Publicly Released: Oct 30, 2013.
Since 2008, the Health Resources and Services Administration (HRSA) within the Department of Health and Human Services (HHS) has awarded five contracts to research organizations to update national workforce projections, but HRSA has failed to publish any new reports containing projections. As a result, the most recent projections from HRSA available to Congress and others to inform health care wor...
Health Care Workforce: Federally Funded Training Programs in Fiscal Year 2012
GAO-13-709R: Published: Aug 15, 2013. Publicly Released: Sep 16, 2013.
In fiscal year (FY) 2012, we found that four federal departments--the Department of Health and Human Services (HHS), Department of Veterans Affairs (VA), Department of Defense, and Department of Education--administered 91 programs that supported postsecondary training or education specifically for direct care health professionals. The departments reported obligating about $14.2 billion for these p...
Medicare: Information on Highest-Expenditure Part B Drugs
GAO-13-739T: Published: Jun 28, 2013. Publicly Released: Jun 28, 2013.
Medicare expenditures for Part B drugs in 2010 were concentrated among relatively few drugs. The 55 highest-expenditure Part B drugs represented $16.9 billion in spending, or about 85 percent of all Medicare spending on Part B drugs, and the 10 highest-expenditure drugs accounted for about 45 percent of all Part B drug spending in 2010. Most of these drugs were under patent and could be purchased...
Preventive Health Activities: Available Information on Federal Spending, Cost Savings, and International Comparisons Has Limitations
GAO-13-49: Published: Dec 6, 2012. Publicly Released: Jan 7, 2013.
The Departments of Health and Human Services (HHS), Veterans Affairs (VA), and Defense (DOD) administer programs that include preventive health activities such as health screenings and education campaigns, but the departments reported that they do not track department-wide spending on these activities. Departments reported that determining such spending is challenging because these activities can...
Medicare: Implementation of Financial Incentive Programs under Federal Fraud and Abuse Laws
GAO-12-355: Published: Mar 30, 2012. Publicly Released: Apr 30, 2012.
Certain financial incentive programs are permitted within the framework of federal fraud and abuse laws, but stakeholders GAO spoke with reported that the laws, regulations, and agency guidance have created challenges for program design and implementation. The Stark law and anti-kickback statute, which restrict financial relationships among providers, have statutory and regulatory exceptions and s...