Defense Health Care: Reimbursement Rates Appropriately Set; Other Problems Concern Physicians

Actions have been taken by DOD and the Congress which complete the action intended by the recommendation. First, DOD provides CHAMPUS maximum allowable charges on the Internet. With the growth and widespread use of the Internet as a business communications medium, this information source helps eliminate the necessity of distributing paper fee schedules. Second, and more importantly, GAO has worked with congressional staff to draft legislative language to replace the term "CHAMPUS maximum allowable charges" with the more-familiar term "Medicare rates," which, when implemented, will eliminate confusion about reimbursement rates. In the near future, when CMAC rates are equivalent to Medicare rates, there will be no need for a TRICARE fee schedule.

DOD stated that the requirement for managed care support contractors to provide balance-billing information on nonparticipating claims has been funded. The managed care support contractors will compose their own messages explaining balance billing limits for the explanation of benefit statements, which explain claim adjudication.