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Medicare: Internal Controls Over Electronic Claims for Anesthesia Services Are Inadequate

HRD-90-49 Published: Dec 18, 1989. Publicly Released: Dec 18, 1989.
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Highlights

Pursuant to a legislative requirement, GAO reviewed Medicare payments to anesthesiologists and verified the anesthesia times claimed.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Health Care Financing Administration The Acting Administrator, HCFA, should reemphasize to carriers that electronic media claims for anesthesia services must show anesthesia times and receive the same prepayment reviews as paper claims.
Closed – Implemented
HCFA issued instructions to intermediaries and carriers on proper processing procedures for electronic claims in its 1992 update of electronic media claims manual instructions.
Health Care Financing Administration The Acting Administrator, HCFA, should require that carriers systematically reconcile time units claimed with anesthesia times reported on the claims.
Closed – Not Implemented
The Omnibus Budget Reconciliation Act (OBRA) 1989 required that anesthesia providers be paid based on actual time. HCFA implementation of this requires anethesia providers to submit times and carriers to calculate the time units. (Fed. Reg., August 7, 1990, p. 32083).
Health Care Financing Administration The Acting Administrator, HCFA, should include periodic assessment of compliance with electronic media processing requirements in HCFA contractor evaluations.
Closed – Implemented
HCFA initiated reviews of contractor compliance with electronic media processing requirements.

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Topics

Health Care
Electronic data processingBilling proceduresClaims processingData collectionInformation systemsInternal controlsMedical expense claimsMedical services ratesMedicareSurgery