Need To Eliminate Payments for Unnecessary Hospital Ancillary Services
HRD-83-74
Published: Sep 30, 1983. Publicly Released: Sep 30, 1983.
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Highlights
At 16 hospitals, GAO arranged for professional standards review organizations to examine the medical necessity of ancillary services provided to Medicare beneficiaries.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator of the Health Care Financing Administration to require professional review organizations to review and report on the medical necessity of hospital ancillary services and use the results as necessary to adjust the database, which will be used to establish the prospective payment rates for future years, starting in fiscal year 1986. |
Closed – Not Implemented
The agency disagreed with the recommendation and intends to take no action. GAO continues to believe that the only way the agency can be sure that the cost of unnecessary ancillary services is removed from the database to be used to revise the prospective payment rates is to review the utilization of ancillary services from a medical necessity viewpoint.
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Health care costsHealth care servicesHospital administrationMonitoringMedicareHospitalsMedicaidTherapyPhysiciansPatient care