Medicare: Information Needed to Assess Payments to Providers
HRD-91-113
Published: Aug 08, 1991. Publicly Released: Aug 08, 1991.
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Highlights
GAO reviewed Medicare tentative settlements of institutional providers' claims to determine: (1) whether such settlements resulted in excessive overpayments; and (2) the results of those excessive overpayments.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Health Care Financing Administration | To improve the completeness and accuracy of Medicare information databases, the Administrator, HCFA, should instruct intermediaries to record data on all tentative settlements in STAR. |
Closed – Implemented
HCFA instructed intermediaries via program memorandum that recording tentative settlement information in the STAR system was now mandatory.
|
| Health Care Financing Administration | To improve the completeness and accuracy of Medicare information databases, the Administrator, HCFA, should reemphasize to intermediaries the requirement to record tentative settlement data accurately and promptly in HCRIS. |
Closed – Implemented
HCFA believes that if data is recorded in the STAR system, it should be sufficient to be a requirement to report in HCRIS. However, this change will make it more difficult to use a centralized system to monitor tentative settlements.
|
| Health Care Financing Administration | To improve the completeness and accuracy of Medicare information databases, the Administrator, HCFA, should improve monitoring of HCRIS and STAR to ensure the integrity of the data in both systems. |
Closed – Implemented
HCFA agreed to improve monitoring of both HCRIS and STAR.
|
| Health Care Financing Administration | Once those improvements are made, the Administrator, HCFA, should analyze the data to determine the reasons for inaccurate tentative settlements and, if warranted, initiate corrective measures to minimize the problems. |
Closed – Not Implemented
HCFA stated that analysis of data alone would not be informative or worthwhile. However, it thought that improved STAR data would put the Medicare fiscal intermediary in a better position to improve accuracy of tentative settlements.
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Topics
Claims settlementHealth care cost controlInformation systemsInsurance claimsInsurance companiesManagement information systemsMedicareOverpaymentsTrust fundsHealth care finance