Medical expense claims (61 - 68 of 68 items)
Survey of Medicare Clinics in Florida
120152: Mar 9, 1979
A survey was conducted of regional Medicare clinics to determine whether adequate controls existed to monitor potential overutilization of the clinics by eligibles.GAO found that the Health Care Financing Administration and the Florida carriers generally were aware of the problem and were taking action to control it by special utilization review procedures. However, a review of the Florida carrier...
Implementation of Reimbursement Procedures for Outpatient Dialysis Treatments Under the End Stage Renal Disease Program of Medicare
120174: Apr 3, 1979
GAO completed a survey of the implementation of reimbursement procedures for outpatient dialysis treatments under the end stage renal disease program.At the time legislation was enacted authorizing Medicare end-stage renal disease program, few data were available on the cost of providing dialysis treatments. To have the program operational, interim rates were established. Medicare Bureau efforts t...
Survey of Controls Used by Medicare Carriers To Prevent Duplicate Payments
104772: Jan 11, 1978
A survey was conducted of Medicare carriers' use of prepayment computer edits to prevent duplicate payments. Bureau instructions specify editing criteria to be used by carriers in screening claims to identify duplicate claims to be disallowed without clerical intervention and potential duplicate claims to be subjected to manual review. Although use of these criteria is mandatory, most of the carri...
OPM Should Promote Medical Necessity Programs for Federal Employees' Health Insurance
HRD-80-79: Published: Jul 29, 1980. Publicly Released: Aug 8, 1980.
Medical necessity programs were developed to help contain health care costs and promote good health care. They can reduce the incidence of, and payment for, health care procedures not found to be medically necessary or consistent with generally acceptable medical practice. Federal Employees' Health Benefits Program plans have varied greatly in their use of medical necessity programs, but data from...
Stronger Management Needed To Improve Employee Organization Health Plans' Payment Practices
HRD-79-87: Published: Sep 7, 1979. Publicly Released: Sep 17, 1979.
The Office of Personnel Management (OPM) has not done an effective job of guiding and overseeing the Employee Organization Plans participating in the Federal Employees Health Benefits program. OPM has allowed the plans to make claim payments without determining whether the claims represented sound comprehensive systems to determine the reasonableness of charges as the contracts require.The Plans h...
More Can Be Done To Achieve Greater Efficiency in Contracting for Medicare Claims Processing
HRD-79-76: Published: Jun 29, 1979. Publicly Released: Jun 29, 1979.
Most Medicare benefits are administered by the Department of Health, Education, and Welfare (HEW) through contracts with private insurance companies called intermediaries, which pay bills for services provided by health care facilities, and other contractors called carriers, which pay claims for services from doctors and suppliers. These contracts have been on a cost reimbursable basis, with neith...
Problems in Carrying Out Medicaid Recovery Programs from Third Parties
HRD-77-73: Published: May 2, 1977. Publicly Released: May 2, 1977.
There are problems involved in implementing the third-party recovery programs which are required to be part of the states' Medicaid programs.Third parties, such as health or automobile accident insurance companies, may be liable to pay part or all of the medical costs of injury, disease, or disability of a Medicaid applicant or recipient. States are responsible for identifying and recovering funds...
More Civil Service Commission Supervision Needed To Control Health Insurance Costs for Federal Employees
HRD-76-174: Published: Jan 14, 1977. Publicly Released: Jan 14, 1977.
GAO was requested to determine what the two governmentwide carriers, Blue Cross and Blue Shield and the Aetna Life Insurance Company, and the Civil Service Commission (CSC) are doing to control health care costs under the Federal Employees Health Benefits program.Benefit payments have been made without conforming to contract or policy requirements and without enough information to determine whethe...