Medicare: Need for Consistent National Payment Policy for Special Anesthesia Services
HRD-91-23
Published: Mar 13, 1991. Publicly Released: Mar 13, 1991.
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Highlights
Pursuant to a legislative requirement, GAO reviewed Medicare's anesthesia payment system, focusing on the: (1) extent to which carriers used modifier units to allow extra payments for factors such as patient age, physical status, or unusual risk circumstances; and (2) appropriateness of such payments.
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, HCFA, to establish a consistent national policy for Medicare payments for anesthesia procedures. As part of the effort to establish a fee schedule for anesthesia services based on the resource-based relative value scale, the appropriateness of any additional payments for modifiers and special monitoring procedures should be assessed. If such payments are not justified, HCFA should ensure that prior carrier payment policies for modifiers and special patient monitoring do not influence payment levels under the fee schedule. |
The Department of Health and Human Services (HHS) believes that the potential effect on payment rates under the fee schedule is too small to justify the effort needed to address the recommendation. Because the fee schedule will be effective January 1, 1991, further pursuit would be futile.
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