Screening Mammography:

Higher Medicare Payments Could Increase Costs Without Increasing Use

HRD-93-50: Published: Apr 22, 1993. Publicly Released: May 25, 1993.

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Pursuant to a congressional request, GAO reviewed the Medicare Program's payment levels and billing procedures for screening mammography, focusing on whether: (1) Medicare payments should be increased so physicians would increase mammography availability by offering it in their offices; and (2) physicians who contract with leasing firms for screening mammography services have problems with Medicare billing procedures.

GAO found that: (1) it would not be cost-effective to attempt to increase mammography use by increasing the Medicare payment cap for screening mammograms, since low-volume machines' higher unit costs could discourage some women from obtaining mammograms because of higher copayments; (2) educational programs and encouraging regular physician referrals to screening facilities are more promising and cost-effective approaches for increasing mammography screening; (3) enough mammography screening capacity exists without physicians setting up additional, higher-cost machines in their offices; (4) some physicians are confused by the Health Care Financing Administration's (HCFA) inconsistent billing guidance and differing Medicare regulations for diagnostic and screening mammography; and (5) in 1990, HCFA adopted a more burdensome billing procedure that requires physicians to bill Medicare and their patients separately for the professional and technical components of their mammography services, which results in four bills for each procedure.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: HHS concurred with the recommendation and has continued to promote screening mammography for Medicare-eligible women.

    Recommendation: The Secretary of Health and Human Services should review the Department of Health and Human Services' screening mammography education programs for both beneficiaries and physicians and determine whether the programs should be strengthened to encourage more Medicare-eligible women to receive mammograms.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: On September 30, 1994, HHS issued its final rule on Medicare coverage of screening mammography. The rule modified and clarified the billing and payment requirements but did not specifically address billing for services provided under package leasing arrangements.

    Recommendation: The Secretary of Health and Human Services should require the Administrator, HCFA, to issue guidance to the carriers allowing combined billing for the professional and technical components of screening mammography services provided under package leasing arrangements.

    Agency Affected: Department of Health and Human Services

 

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