Contractor Services to Beneficiaries and Providers

HRD-88-76BR: Published: Mar 16, 1988. Publicly Released: Apr 19, 1988.

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GAO assessed the level of beneficiary and provider satisfaction with the Health Care Financing Administration's (HCFA) Medicare services program, specifically: (1) claims processing timeliness and accuracy; (2) responsiveness to beneficiary and provider inquiries; and (3) the processes available to beneficiaries and providers to dispute decisions about reimbursement and program coverage.

GAO found that: (1) claims processing time increased each year between 1983 and 1986, with the longest times occurring between 1985 and 1986; (2) the increases were due to increased claims and HCFA program and policy changes intended to achieve budget reductions; (3) the accuracy of carriers' claims processing decreased between 1983 and 1985, reaching its highest error rate in 1985; (4) between 1983 and 1986, carriers had a greater portion of cases waiting review 60 days or more and of hearings cases pending 120 days or more; (5) although HCFA standards required contractors to respond to 95 percent of written inquiries within 30 days, prior to 1987 only about 65 percent of contractors met the standard; and (6) HCFA and contractor officials stated that the improved 1987 contractor performance was due to legislative requirements and increased emphasis on service during HCFA evaluations.

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