Medicare (81 - 90 of 214 items)
Medicare Physician Payments: Concerns about Spending Target System Prompt Interest in Considering Reforms
GAO-05-85: Published: Oct 8, 2004. Publicly Released: Oct 8, 2004.
Concerns were raised about the current system Medicare uses to determine annual changes to physician fees--the sustainable growth rate (SGR) system--when fees were reduced by 5.4 percent in 2002. Subsequent administrative and legislative actions modified or overrode the SGR system, resulting in fee increases for 2003, 2004, and 2005. However, projected fee reductions for 2006-2012 have raised new...
Medicare Preventive Services: Most Beneficiaries Receive Some but Not All Recommended Services
GAO-04-1004T: Published: Sep 21, 2004. Publicly Released: Sep 21, 2004.
Preventive care depends on identifying health risks and on taking steps to control these risks. In contrast, Medicare, the federal health program insuring almost 35 million beneficiaries age 65 or older, was established largely to help pay beneficiaries' health care costs when they became ill or injured. Congress has broadened Medicare coverage over time to include specific preventive services, su...
Milwaukee Health Care Spending Compared to Other Metropolitan Areas: Geographic Variation in Spending for Enrollees in the Federal Employees Health Benefits Program
GAO-04-1000R: Published: Aug 18, 2004. Publicly Released: Aug 23, 2004.
Health care spending varies across the country due to differences in the use and price of health care services. Understanding the reasons for utilization and price variation may contribute to developing methods to control health care spending. This report provides preliminary results from our work on geographic variations in health care spending and prices. Congress asked us to examine geographic...
Medicare Physician Payments: Information on Spending Trends and Targets
GAO-04-751T: Published: May 5, 2004. Publicly Released: May 5, 2004.
The Sustainable Growth Rate (SGR) system, implemented in 1998 and subsequently revised, is used to update Medicare's physician fees and moderate the growth in Medicare spending for physician services. SGR, and a predecessor system implemented in 1992, were designed to reduce physician fee updates if spending growth exceeded a specified target. Although spending growth slowed substantially under bo...
Comptroller General's Forum on Health Care: Unsustainable Trends Necessitate Comprehensive and Fundamental Reforms to Control Spending and Improve Value
GAO-04-793SP: Published: May 1, 2004. Publicly Released: May 1, 2004.
Unrelenting growth in health care spending has put pressure on policymakers to seek health care system reforms. The stress comes partly from a wide gap in expectations between what health care Americans want and what the nation can afford and sustain. GAO's Health Care Forum was held on January 13, 2004, to find ways to elevate the nation's understanding of health care cost, access, and quality ch...
Medicare Provider Enrollment: Opportunities to Enhance Program Integrity Efforts
GAO-03-185: Published: Mar 17, 2003. Publicly Released: Mar 17, 2003.
Staffing companies that contract with physicians to staff hospital departments--including emergency departments--are not permitted to bill Medicare. In the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Congress directed GAO to assess the program integrity implications of enrolling these companies and allowing them to bill Medicare. GAO reviewed about 2.8 million em...
VA Health Care: Third-Party Collections Rising as VA Continues to Address Problems in Its Collections Operations
GAO-03-145: Published: Jan 31, 2003. Publicly Released: Mar 3, 2003.
The Department of Veterans Affairs (VA) collects health insurance payments, known as third-party collections, for veterans' health care conditions it treats that are not a result of injuries or illnesses incurred or aggravated during military service. In September 1999, VA adopted a new fee schedule, called "reasonable charges," that it anticipated would increase revenues from third-party collecti...
Medicare Physician Payments: Medical Settings and Safety of Endoscopic Procedures
GAO-03-179: Published: Oct 18, 2002. Publicly Released: Oct 18, 2002.
Every year millions of Americans covered by Medicare undergo endoscopic medical procedures in a variety of health care settings ranging from physicians' offices to hospitals. These invasive procedures call for the use of a lighted, flexible instrument and are used for screening and treating disease. Although some of these procedures can be performed while the patient is fully awake, most require s...
Medicare Hospital and Physician Payments: Geographic Cost Adjustments Important to Preserve Beneficiary Access to Services
GAO-02-968T: Published: Jul 23, 2002. Publicly Released: Jul 23, 2002.
This testimony discusses Medicare program payment adjustments to hospitals and physicians that account for geographic differences in costs. Because Medicare's hospital and physician payment systems are based on national rates, these geographic cost adjustments are essential to account for costs beyond providers' control and to ensure that beneficiaries have adequate access to services. If these ad...
Medicare: Recent CMS Reforms Address Carrier Scrutiny of Physicians' Claims for Payment
GAO-02-693: Published: May 28, 2002. Publicly Released: May 28, 2002.
In 1990, GAO designated the Medicare program to be at high-risk for waste, fraud, and abuse. More than a decade later, Medicare remains on GAO's high-risk list. This report examines Medicare's claims review process, which is designed to detect improper billing or payments. GAO found that most physicians who bill Medicare are largely unaffected by carriers' medical reviews, with 90 percent of physi...