Medicare:

Contractor Services to Beneficiaries and Providers

HRD-88-76BR: Published: Mar 16, 1988. Publicly Released: Apr 19, 1988.

Additional Materials:

Contact:

Office of Public Affairs
(202) 512-4800
youngc1@gao.gov

GAO assessed the level of beneficiary and provider satisfaction with the Health Care Financing Administration's (HCFA) Medicare services program, specifically: (1) claims processing timeliness and accuracy; (2) responsiveness to beneficiary and provider inquiries; and (3) the processes available to beneficiaries and providers to dispute decisions about reimbursement and program coverage.

GAO found that: (1) claims processing time increased each year between 1983 and 1986, with the longest times occurring between 1985 and 1986; (2) the increases were due to increased claims and HCFA program and policy changes intended to achieve budget reductions; (3) the accuracy of carriers' claims processing decreased between 1983 and 1985, reaching its highest error rate in 1985; (4) between 1983 and 1986, carriers had a greater portion of cases waiting review 60 days or more and of hearings cases pending 120 days or more; (5) although HCFA standards required contractors to respond to 95 percent of written inquiries within 30 days, prior to 1987 only about 65 percent of contractors met the standard; and (6) HCFA and contractor officials stated that the improved 1987 contractor performance was due to legislative requirements and increased emphasis on service during HCFA evaluations.

Sep 15, 2016

Sep 14, 2016

Sep 12, 2016

Sep 9, 2016

Sep 6, 2016

Aug 31, 2016

Looking for more? Browse all our products here