Medicare:

Simplified Processing of Deceased Beneficiaries' Claims to Be Implemented

HRD-88-99: Published: Jun 21, 1988. Publicly Released: Jul 22, 1988.

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Pursuant to a congressional request, GAO assessed the timeliness of the Health Care Financing Administration's (HCFA) processing of deceased beneficiary claims under its Medicare program, focusing on 31 cases which represented examples of processing delays.

GAO found that: (1) in general, the 31 claims were more complicated than typical claims; (2) claims processing procedures contributed to delayed benefits payments for 24 claims; (3) establishing the medical necessity of claimed services and determining other insurance carriers' liabilities, delayed benefits payments for 18 cases; and (4) factors unrelated to claims processing procedures caused benefit payment delays for seven claims. GAO also found that HCFA plans to implement nationally a revised procedure which reduced processing time and administrative costs for deceased beneficiary claims during a 2-month test period.

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