Year 2000 Computing Crisis:

Status of Medicare Providers Unknown

AIMD-99-243: Published: Jul 28, 1999. Publicly Released: Aug 6, 1999.

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Pursuant to a congressional request, GAO reviewed the: (1) Health Care Financing Administration's (HCFA) outreach and testing efforts for ensuring that Medicare providers will be year 2000 compliant; and (2) surveys that have been completed to date or planned on the year 2000 status of healthcare providers.

GAO noted that: (1) HCFA has taken comprehensive measures in conducting its outreach activities; (2) for example, the HCFA Administrator sent individual letters to over 1.1 million Medicare providers in January and May of this year, alerting them to take prompt year 2000 action on their information and billing systems; (3) in addition, HCFA held a series of year 2000 conferences throughout the country and has established a toll-free information hotline; (4) despite these aggressive actions, however, HCFA data show that provider participation in its outreach activities has been low; (5) further, HCFA has tasked contractors that process Medicare claims to test with providers using future dated claims; (6) as of June 21, 1999, Medicare contractor testing with providers had been limited and testing that has occurred had identified problems; (7) for example, HCFA reported that one contractor tested with 434 providers and encountered initial problems with 123--9 of which were considered critical failures; (8) many surveys have been completed this year on the year 2000 readiness of healthcare providers by healthcare trade associations and other organizations; (9) however, none of the 11 surveys GAO reviewed provided sufficient information with which to assess the year 2000 status of the healthcare provider community; and (10) each of the surveys had low response rates and several did not address critical questions about testing and contingency planning.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: HCFA established a provider outreach team and conducted outreach activities. It conducted testing with contractors and set a goal for contractor testing with providers/submitters. A substantial percentage of providers/submitters, representing about half of HCFA's overall claims volume, were tested. HCFA also posted some results of contractor/provider testing on its website.

    Recommendation: In order to reduce the risk of year 2000-related failures of the Medicare provider community and ensure that the public has adequate information about what is being done to reduce the risk of such failures, HCFA should: (1) continue to solicit suggestions from healthcare provider trade associations on how to increase participation in outreach activities; (2) consider using additional outreach methods, such as public service announcements; (3) consider conducting end-to-end tests with providers and Medicare contractors on a sample basis, if time permits; (4) set milestones for Medicare contractors to test with providers; and (5) continue to publicize the results of all contractor/provider testing on HCFA's web site.

    Agency Affected: Department of Health and Human Services: Health Care Financing Administration

  2. Status: Closed - Implemented

    Comments: The Healthcare Sector Working Group did continue to encourage associations to survey and conduct other outreach with the medical provider community. However it did not develop a template.

    Recommendation: The healthcare sector working group of the President's Council on Year 2000 Conversion should: (1) develop a template to ensure that future surveys include critical questions on testing and contingency planning and to ensure that assessments are categorized into areas such as billing/medical record systems, biomedical devices, and infrastructure; and (2) consider working with associations to publicize those providers who respond to future surveys in order to increase survey response rates.

    Agency Affected: President's Council on Year 2000 Conversion: Healthcare Sector Working Group


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