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Medicare: HCFA Can Reduce Paperwork Burden for Physicians and Their Patients

HRD-90-86 Published: Jun 20, 1990. Publicly Released: Jun 20, 1990.
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Highlights

Pursuant to a congressional request, GAO reviewed the claims process for Medicare physician services to determine whether: (1) opportunities exist to help providers submit more complete claims; (2) notices to beneficiaries explain claims decisions clearly; and (3) electronic services, such as electronic mail, could reduce paperwork.

Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Health and Human Services The Secretary of Health and Human Services should direct the Administrator, HCFA, to: (1) identify effective techniques for reducing the number of incomplete claims filed by providers; and (2) encourage carriers to adopt those techniques when appropriate.
Closed – Implemented
HCFA has revised the 1500 claim form plus instructions. This should help providers to complete claim forms more accurately. The new form and instructions were issued late in 1991. Providers are required to answer questions on the 1500 claim form regarding other insurance, effective October 1, 1991. Claims submitted after April 1, 1992 with this information missing will be denied.
Department of Health and Human Services The Secretary of Health and Human Services should direct the Administrator, HCFA, to initiate a concerted effort with carriers and beneficiaries to improve the quality of notices and messages. Specifically, HCFA should establish a formal mechanism to solicit feedback from carriers and beneficiaries on benefit notice problems and use the feedback to improve notices and messages.
Closed – Implemented
HCFA initiated a significant effort to redesign the form and content of the explanation of Medicare benefits (EOMB). HCFA contracted with a design firm to revise EOMB. The design firm held meetings with focus groups (beneficiaries, AARP, etc.) to solicit their suggestions. A new EOMB was implemented in late 1991.
Department of Health and Human Services The Secretary of Health and Human Services should direct the Administrator, HCFA, to initiate a concerted effort with carriers and beneficiaries to improve the quality of notices and messages. Specifically, HCFA should, during annual carrier evaluations, examine the messages used on benefit notices to ensure that information is clear and necessary.
Closed – Implemented
HCFA has initiated a significant effort to redesign the form and content of EOMB. HCFA contracted with a design firm to revise EOMB. The design firm held meetings with focus groups (beneficiaries, AARP, etc.) to solicit their suggestions. A new EOMB was implemented in late 1991.
Department of Health and Human Services The Secretary of Health and Human Services should direct the Administrator, HCFA, to initiate a concerted effort with carriers and beneficiaries to improve the quality of notices and messages. Specifically, HCFA should monitor carriers to ensure that notices are sent to beneficiaries in all required cases so that beneficiaries will have the opportunity to detect potential payment errors or fraudulent claims.
Closed – Implemented
HCFA requires that carriers send an explanation of Medicare benefits (EOMB) to beneficiaries in all cases except for laboratory charges. Because of funding restraints, HCFA does not require carriers to send EOMB for laboratory charges due to the large volume of claims. If funding becomes available, HCFA would require that EOMB be sent for laboratory charges; however increased funding is unlikely.
Department of Health and Human Services The Secretary of Health and Human Services should direct the Administrator, HCFA, to assume a leadership role in further automating the claims process and specifically identify the innovations in electronic claims filing systems and electronic communications that Medicare carriers and commercial insurers have instituted.
Closed – Implemented
HCFA has submitted legislative proposals to encourage increased numbers of submissions of electronic claims. HCFA proposed that electronic claims be paid 10 to 14 days faster than paper claims. The FY 1993 appropriations bill was passed with a provision for paying electronic claims 13 days faster.
Department of Health and Human Services The Secretary of Health and Human Services should direct the Administrator, HCFA, to assume a leadership role in further automating the claims process and specifically disseminate information on such innovations to carriers to facilitate the implementation of these innovations throughout Medicare.
Closed – Implemented
HCFA has submitted legislative proposals to encourage increased numbers of submissions of electronic claims. The FY 1993 appropriations bill was passed with such a provision setting a 14-day floor for electronic media claims versus a 27-day floor for paper claims. It is effective for FY 1993 and 1994 so HCFA has included a permanent provision in its FY 1994 appropriations bill.

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Topics

BeneficiariesBilling proceduresClaims processingClaims processing costsElectronic formsHealth care cost controlInsurance claimsMedical expense claimsMedicarePhysicians