Medical expense claims (1 - 10 of 64 items)
Private Health Insurance: Early Effects of Medical Loss Ratio Requirements and Rebates on Insurers and Enrollees
GAO-14-580: Published: Jul 10, 2014. Publicly Released: Jul 10, 2014.
The Patient Protection and Affordable Care Act (PPACA) established federal minimum medical loss ratio (MLR) standards for the percentage of premiums private insurers must spend on their enrollees' medical care claims and activities to improve health care quality, as opposed to what they spend on administrative (“non-claims”) costs. Insurers report to the Centers for Medicare & Medicaid Service...
Private Health Insurance: Early Indicators Show That Most Insurers Would Have Met or Exceeded New Medical Loss Ratio Standards
GAO-12-90R: Published: Oct 31, 2011. Publicly Released: Nov 30, 2011.
To help ensure that millions of Americans who rely on private insurance for health care coverage receive value for their premium dollars, the Patient Protection and Affordable Care Act (PPACA) established minimum "medical loss ratio" (MLR) standards for insurers. The MLR is a basic financial indicator, traditionally referring to the percentage of insurance premium revenues health insurers spent on...
Private Health Insurance: Early Experiences Implementing New Medical Loss Ratio Requirements
GAO-11-711: Published: Jul 29, 2011. Publicly Released: Aug 29, 2011.
To help ensure that Americans receive value for their premium dollars, the Patient Protection and Affordable Care Act (PPACA) established minimum "medical loss ratio" (MLR) standards for health insurers. The MLR is a basic financial indicator, traditionally referring to the percentage of premiums spent on medical claims. The PPACA MLR is defined differently from the traditional MLR. Beginning in 2...
Medicare Secondary Payer: Process for Situations Involving Non-Group Health Plans
GAO-11-726T: Published: Jun 22, 2011. Publicly Released: Jun 22, 2011.
The Centers for Medicare & Medicaid Services (CMS) is responsible for protecting the Medicare program's fiscal integrity and ensuring that it pays only for those services that are its responsibility. Medicare Secondary Payer (MSP) provisions make Medicare a secondary payer to certain group health plans (GHP) and non-group health plans (NGHP), which include auto or other liability insurance, no-fau...
VA Health Care: Ineffective Medical Center Controls Resulted in Inappropriate Billing and Collection Practices
GAO-10-152T: Published: Oct 15, 2009. Publicly Released: Oct 15, 2009.
GAO was asked to testify on billing practices of the Department of Veterans Affairs (VA). GAO previously reported that continuing problems in billing and collection processes at VA impaired its ability to maximize revenue from private insurance companies (third-party insurers). In June 2008, GAO reported on its follow-up review that (1) evaluated VA billing controls, (2) assessed VA-wide controls...
Health Insurance: Enrollment, Benefits, Funding, and Other Characteristics of State High-Risk Health Insurance Pools
GAO-09-730R: Published: Jul 22, 2009. Publicly Released: Aug 21, 2009.
A growing number of states--35 as of June 2009--have created high-risk health insurance pools (HRPs) primarily to provide coverage to individuals whose health status limits their access to coverage in the private individual health insurance market. HRPs--typically state-run nonprofit associations--often contract with a private health insurance carrier to administer the pool and offer a range of he...
VA Health Care: Ineffective Controls over Medical Center Billings and Collections Limit Revenue from Third-Party Insurance Companies
GAO-08-675: Published: Jun 10, 2008. Publicly Released: Jul 10, 2008.
GAO previously reported that continuing problems in billing and collection processes at the Department of Veterans Affairs (VA) impaired VA's ability to maximize revenue from private (third-party) insurance companies. VA has undertaken several initiatives to address these weaknesses. GAO was asked to perform a follow-up audit to (1) evaluate VA billing controls, (2) assess VA-wide controls for col...
Health Savings Accounts: Participation Grew, and Many HSA-Eligible Plan Enrollees Did Not Open HSAs while Individuals Who Did Had Higher Incomes
GAO-08-802T: Published: May 14, 2008. Publicly Released: May 14, 2008.
With health care spending increasing, Congress enacted legislation effective in 2004 establishing Health Savings Accounts (HSA) to be coupled with eligible high-deductible health plans. The novel structure of eligible health plans coupled with HSAs has raised questions about who selects them and how they are used. Proponents contend that the lower premiums of the health plans and the tax-free savi...
Health Savings Accounts: Participation Increased and Was More Common among Individuals with Higher Incomes
GAO-08-474R: Published: Apr 1, 2008. Publicly Released: Apr 30, 2008.
With health care spending increasing in the United States, you enacted legislation effective in 2004 establishing tax advantaged health savings accounts (HSA) to be coupled with high-deductible health insurance plans. HSA-eligible high-deductible health plans typically have lower premiums than traditional health plans and HSAs allow account holders to accumulate tax-free savings to pay for medical...
Medicare: Concerns Regarding Plans to Transfer the Appeals Workload from SSA to HHS Remain
GAO-05-703R: Published: Jun 30, 2005. Publicly Released: Aug 1, 2005.
Medicare--the federal health insurance program that covers the nation's elderly and disabled--annually processes over 1 billion medical claims for services provided to beneficiaries. The Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), administers the Medicare program with the assistance of its claims administration contractors. Th...