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Medicare Part A Reimbursements: Processing of Appeals Is Slow

HRD-90-23BR Published: Feb 09, 1990. Publicly Released: Mar 15, 1990.
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Highlights

Pursuant to a legislative requirement, GAO assessed the adequacy of the Provider Reimbursement Review Board's (PRRB) staffing levels, focusing on: (1) whether the Health Care Financing Administration's (HCFA) limited staff allocations impaired PRRB ability to process health care agencies' appeals of denied Medicare reimbursement claims by limiting staff allocations; and (2) PRRB timeliness in processing those cases.

Recommendations

Matter for Congressional Consideration

Matter Status Comments
If the Senate Committee on Appropriations wishes to directly monitor the level of resources requested for PRRB operations, it may wish to consider directing that PRRB be identified separately in the HHS appropriation request.
Closed – Not Implemented
Congress has not yet responded to this matter for consideration, but has mandated that a related board be established in HHS which may accomplish the intent of the recommendation. No further action on this matter is expected.

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health and Human Services should direct that HCFA and PRRB work together to establish an accurate case inventory, determine the number of staff needed to process cases, and reevaluate time frames for each step in the process.
Closed – Implemented
The agency has taken the position that it has responded to the recommendation and that no further actions are needed. While GAO does not believe it has been fully reponsive. No further agency action should be anticipated.

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Administrative remediesAppealsAppellate procedureClaims adjudicatorsClaims settlementHealth care facilitiesInteragency relationsMedical expense claimsMedicareStaff utilization