More Action Needed To Reduce Beneficiary Underpayments
HRD-81-126
Published: Sep 03, 1981. Publicly Released: Oct 01, 1981.
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Highlights
GAO assessed the procedures for reviewing unassigned Medicare claims where significant portions were disallowed for payment. The assessment was undertaken to determine how the safeguards established by Medicare carriers to identify potential underpayments associated with reasonable charge reductions were being applied. This assessment was performed as follow-on work to an earlier report addressing four areas where Medicare beneficiaries were subject to inequitable out-of-pocket costs for services covered by Medicare. In addition, GAO assessed actions taken by the Department of Health and Human Services (HHS) on recommendations made in that report.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | To provide greater assurance that safeguards for identifying potential underpayments are effective, the Secretary of HHS should direct the Administrator of the HCFA to modify the Contractor Performance Evaluation Program for Part B carriers to place additional emphasis on detecting and preventing underpayments. Specifically, the Quality Assurance Program should address, as a separate category of error, the quality of the review of claims that exceed the carriers' high charge reduction safeguards. |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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Topics
BeneficiariesContract performanceInsurance companiesMedical expense claimsMedicareStandards evaluationUnderpaymentsMedical proceduresPhysiciansQuality assurance