Claims processing (51 - 60 of 188 items)
Medicare: Using Education and Claims Scrutiny to Minimize Physician Billing Errors
GAO-02-778T: Published: May 28, 2002. Publicly Released: May 28, 2002.
In its audit for year 2001, the Department of Health and Human Services' Office of Inspector General found that $12.1 billion was improperly paid to Medicare providers. GAO's February report (GAO-02-249) showed that physicians often do not receive complete, accurate, clear, or timely guidance on Medicare billing and payment policies. At the carriers studied, GAO found significant shortcomings in p...
Medicare: Improvements Needed in Provider Communications and Contracting Procedures
GAO-01-1141T: Published: Sep 25, 2001. Publicly Released: Sep 25, 2001.
Complete, accurate, and timely communication of program information is necessary to help Medicare providers comply with program requirements and appropriately bill for their services. Information provided to physicians about billing and payment policies is often incomplete, confusing, out of date, or even incorrect. GAO found that the rules governing Centers for Medicare and Medicaid Services (CMS...
Medicare: Comments on HHS' Claims Administration Contracting Reform Proposal
GAO-01-1046R: Published: Aug 17, 2001. Publicly Released: Sep 10, 2001.
The Department of Health and Human Services (HHS) submitted a legislative proposal that would modify Medicare's contracting authority. This report examines (1) the current law and practice in Medicare claims administration contracting, (2) provisions in the proposal that would increase HHS Centers for Medicare and Medicaid Services' (CMS) contracting flexibility, and (3) the provisions that deviat...
Medicare Management: CMS Faces Challenges to Sustain Progress and Address Weaknesses
GAO-01-817: Published: Jul 31, 2001. Publicly Released: Aug 31, 2001.
Considering the complexity, the size, and the statutory constraints affecting the Medicare Program, some contend that the Health Care Financing Administration's (HCFA)--recently renamed the Centers for Medicare and Medicaid Services--management of Medicare has, on balance, been satisfactory. Others argue that HCFA's management has been unacceptable. HCFA's record has been mixed and the agency's ch...
Medicare Contracting Reform: Opportunities and Challenges in Contracting for Claims Administration Services
GAO-01-918T: Published: Jun 28, 2001. Publicly Released: Jun 28, 2001.
Discussions about how to reform and modernize the Medicare Program have, in part, focused on whether the structure that was adopted in 1965 is optimal today. Questions have been raised about whether the program could benefit from changes to the way that Medicare's claims processing contractors are chosen and the jobs they do. Medicare could benefit from full and open competition and its relative f...
Medicare Management: Current and Future Challenges
GAO-01-878T: Published: Jun 19, 2001. Publicly Released: Jun 19, 2001.
Medicare is a popular program that millions of Americans depend on for covering their essential health needs. However, the management of the program has fallen short of expectations because it has not always appropriately balanced or satisfied the needs of beneficiaries, providers, and taxpayers. For example, stakeholders expect that Medicare will price services prudently; that providers will be t...
Medicare: Post-Hearing Questions Related to Financial and Information Technology Management
GAO-01-275R: Published: Dec 21, 2000. Publicly Released: Dec 21, 2000.
This correspondence answers congressional questions about financial and information technology management of the Medicare Program. Among the topics discussed are claims processing, management of statistical data, and computer viruses. For example, in reference to claims processing, GAO found that, as of December 2000, Medicare carriers and fiscal intermediaries use six standard claims processing s...
Medicare Improper Payments: While Enhancements Hold Promise for Measuring Potential Fraud and Abuse, Challenges Remain
AIMD/OSI-00-281: Published: Sep 15, 2000. Publicly Released: Sep 15, 2000.
Pursuant to a congressional request, GAO provided information on the structural problems that exist in the Medicare claims processing system, focusing on: (1) what the Health Care Financing Administration (HCFA) proposals have been designed or initiated to measure Medicare improper payments; and (2) the status of these proposals and initiatives and how will they enhance HCFA's ability to comprehen...
Medicare Home Health Care: Prospective Payment System Could Reverse Recent Declines in Spending
HEHS-00-176: Published: Sep 8, 2000. Publicly Released: Sep 8, 2000.
Pursuant to a congressional request, GAO provided information on Medicare home health care's recent declines in spending, focusing on: (1) the declines in service use underlying the changes in spending; (2) the extent of the changes in use across beneficiaries, home health agencies (HHA), and locations; and (3) identify any implications these new patterns of home health use have for the impact of...
Medicare: HCFA Could Do More to Identify and Collect Overpayments
HEHS/AIMD-00-304: Published: Sep 7, 2000. Publicly Released: Sep 7, 2000.
Pursuant to a congressional request, GAO provided information on efforts to recover Medicare's overpayments, focusing on: (1) how the Health Care Financing Administration (HCFA) and its contractors identify potential overpayments, and whether techniques used by recovery auditors would improve overpayment identification; (2) how well HCFA and its contractors collect overpayments once they are ident...