Health insurance (21 - 30 of 65 items)
Medicare Physician Payments: Spending Targets Encourage Fiscal Discipline, Modifications Could Stabilize Fees
GAO-02-441T: Published: Feb 14, 2002. Publicly Released: Feb 14, 2002.
Congress implemented a physician fee schedule and a fee update formula to moderate spending growth relative to specified Medicare spending targets. These spending targets increase annually to reflect higher costs for physician services, the growth in the overall economy, and changes in the number of Medicare beneficiaries. Physician fees are adjusted for changes in the costs of providing services...
VA Health Care: VA Has Not Sufficiently Explored Alternatives for Optimizing Third-Party Collections
GAO-01-1157T: Published: Sep 20, 2001. Publicly Released: Sep 20, 2001.
The Department of Veterans Affairs (VA) has reversed the general decline in its third-party collections for the first time since fiscal year 1995. The fiscal year 2001 increase appears to be largely the result of VA's implementation of a new system, known as the reasonable charges billing system, which allowed VA to move from a flat-rate billing system to one that itemizes charges. However, long-s...
Emergency Care: EMTALA Implementation and Enforcement Issues
GAO-01-747: Published: Jun 22, 2001. Publicly Released: Jun 22, 2001.
In 1986, Congress passed the Emergency Medical Treatment and Active Labor Act (EMTALA) in response to reports that some emergency rooms across the country had refused to treat indigent and uninsured patients or had inappropriately transferred them to other hospitals, a practice known as "patient dumping." EMTALA requires hospitals that participate in Medicare to provide a medical screening examina...
Medicare: Improper Third-Party Billing of Medicare by Behavioral Medical Systems, Inc.
OSI-00-5R: Published: Mar 30, 2000. Publicly Released: Apr 11, 2000.
Pursuant to a congressional request, GAO reviewed the operations of Behavioral Medical Systems, Inc.GAO noted that: (1) while BMS represented itself to the Medicare Program as a provider, in fact it functioned as a broker and a third-party biller; (2) GAO found a consistent pattern by which BMS caused improper Medicare claims to be submitted for services not provided by six psychiatrists; (3) of t...
Health Care Financing Administration: Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2000
OGC-00-9: Published: Nov 15, 1999. Publicly Released: Nov 15, 1999.
Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) new rule on Medicare Program revisions to payment policies under the physician fee schedule for calendar year 2000. GAO noted that: (1) the rule would make several changes affecting Medicare Part B payment; (2) the changes include, among others, implementation of resource-based malpractice insuran...
NIH Clinical Trials: Various Factors Affect Patient Participation
HEHS-99-182: Published: Oct 30, 1999. Publicly Released: Nov 1, 1999.
Pursuant to a congressional request, GAO reviewed patient access to clinical trials sponsored by the National Institutes of Health (NIH), focusing on: (1) how health insurers' coverage policies and practices affect patient participation in clinical trials; (2) researchers' experience in enrolling patients for trials sponsored by the National Cancer Institute (NCI) and factors that may explain this...
Managed Care: State Approaches on Selected Patient Protections
T-HEHS-99-85: Published: Mar 11, 1999. Publicly Released: Mar 11, 1999.
Pursuant to a congressional request, GAO discussed selected state patient protection provisions already in place and congressional proposals under consideration, focusing on state statutes that relate to seven types of patient protections: (1) coverage of emergency services; (2) access to obstetricians and gynecologists; (3) access to pediatricians; (4) access to other specialists; (5) continuity...
Specialty Care: Heart Attack Survivors Treated by Cardiologists More Likely to Take Recommended Drugs
HEHS-99-6: Published: Dec 4, 1998. Publicly Released: Jan 4, 1999.
Pursuant to a congressional request, GAO reviewed the potential differences in treatment patterns for health maintenance organizations (HMO) patients treated by specialists and those treated by generalist physicians, focusing on: (1) the proportion of Medicare heart attack survivors enrolled in HMOs who take cholesterol-lowering drugs, beta-blockers, and aspirin; and (2) whether Medicare heart att...
HCFA: Medicare Program--Revisions to Payment Policies and Five-Year Review of and Adjustments to the Relative Value Units and Physician Fee Schedule Update for Calendar Year 1997 Notice
OGC-97-9: Published: Dec 9, 1996. Publicly Released: Dec 9, 1996.
Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) new rule on revisions to the Medicare Program's payment policies and 5-year review of and adjustments to the relative value units under the physician fee schedule for calendar year 1997 and its physician fee schedule update for calendar year 1997 and physician volume performance standard rates of...
Maternity Care: Appropriate Follow-Up Services Critical With Short Hospital Stays
HEHS-96-207: Published: Sep 11, 1996. Publicly Released: Sep 11, 1996.
Pursuant to a congressional request, GAO reviewed issues surrounding shortened postpartum hospital stays, focusing on: (1) the risks that are attributable to short hospital stays for maternity care; (2) health plan actions to ensure quality postpartum care for short-stay newborns; and (3) state responses to concerns about patient protection.GAO found that: (1) many medical personnel are concerned...