Medicare:
HCFA Monitoring of the Quality of Part B Claims Processing
T-PEMD-92-14: Published: Sep 23, 1992. Publicly Released: Sep 23, 1992.
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GAO discussed the Health Care Financing Administration's (HCFA) review of Medicare carrier performance, focusing on its methodological quality. GAO noted that: (1) HCFA has two methods to evaluate carriers' contract performance; (2) the quality assurance program assesses the number of processing errors and payment/deductible errors, which quantify the corresponding dollar amount of processing errors, from a random sample of a carrier's claims; (3) the quality assurance program only assesses the evaluation criteria's reliability and not their appropriateness; (4) the quality assurance program does not directly measure the extent of claim underpayments; (5) the contractor performance evaluation program rates the timeliness and accuracy of claims processing, payment safeguards, compliance with applicable laws, administrative management, and program efficiency; (6) the performance evaluation uses the payment/deductible error rate from the quality assurance assessment, but does not use the number of inaccurately processed claims; (7) the performance evaluation does measure the validity of the carriers' medical screens; and (8) HCFA has not developed a systematic analysis of reversed claims appeals.
Jan 14, 2021
Medicaid:
Data Completeness and Accuracy Have Improved, Though Not All Standards Have Been MetGAO-21-196: Published: Jan 14, 2021. Publicly Released: Jan 14, 2021.
Jan 4, 2021
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Medicare Severe Wound Care:
Spending Declines May Reflect Site of Care Changes; Limited Information Is Available on QualityGAO-21-92: Published: Jan 4, 2021. Publicly Released: Jan 4, 2021.
Dec 22, 2020
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Defense Health Care:
Efforts to Ensure Beneficiaries Access Specialty Care and Receive Timely and Effective CareGAO-21-143: Published: Dec 22, 2020. Publicly Released: Dec 22, 2020.
Dec 16, 2020
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Medicaid Long-Term Services and Supports:
Access and Quality Problems in Managed Care Demand Improved OversightGAO-21-49: Published: Nov 16, 2020. Publicly Released: Dec 16, 2020.
Dec 14, 2020
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Drug Pricing Program:
HHS Uses Multiple Mechanisms to Help Ensure Compliance with 340B RequirementsGAO-21-107: Published: Dec 14, 2020. Publicly Released: Dec 14, 2020. -
Substance Use Disorder:
Reliable Data Needed for Substance Abuse Prevention and Treatment Block Grant ProgramGAO-21-58: Published: Dec 14, 2020. Publicly Released: Dec 14, 2020.
Dec 10, 2020
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Indian Health Service:
Actions Needed to Improve Oversight of Provider Misconduct and Substandard PerformanceGAO-21-97: Published: Dec 10, 2020. Publicly Released: Dec 10, 2020. -
Clinical Labs:
Studies Suggest Biopsy Specimen Misidentification and Contamination Errors Are InfrequentGAO-21-59: Published: Nov 10, 2020. Publicly Released: Dec 10, 2020.
Dec 7, 2020
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Medicaid:
CMS Needs More Information on States' Financing and Payment Arrangements to Improve OversightGAO-21-98: Published: Dec 7, 2020. Publicly Released: Dec 7, 2020.
Dec 1, 2020
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Military Health Care:
Defense Health Agency Processes for Responding to Provider Quality and Safety ConcernsGAO-21-160R: Published: Dec 1, 2020. Publicly Released: Dec 1, 2020.
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