Medicare: Shared Systems Policy Inadequately Planned and Implemented
IMTEC-92-41
Published: Mar 18, 1992. Publicly Released: Mar 18, 1992.
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Highlights
Pursuant to a congressional request, GAO reviewed a 1989 Health Care Financing Administration (HCFA) policy change that encouraged HCFA Medicare claims processing contractors to share automatic data processing (ADP) systems, focusing on: (1) HCFA implementation of the policy change; and (2) the policy's impact on Medicare claims processing.
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 suspend further implementation of its system sharing policy until HCFA completes its evaluation of existing contractor ADP systems to ensure that the systems are in compliance with HCFA basic system requirements. |
The Department of Health and Human Services (HHS) disagreed with the recommendation. The Department stated that it was pleased with the success of the shared systems initiative and had no desire to reverse course. This recommendation was included in the last annual report on open recommendations and is, therefore, now being closed.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to suspend further implementation of its system sharing policy until HCFA uses this evaluation, along with contractor program performance data, to determine which contractors would benefit from a conversion to shared processing and which systems would be the best candidates to convert to. |
HHS disagreed with the recommendation. The Department stated that it was pleased with the success of the shared systems initiative and had no desire to reverse course. This recommendation was included in the last annual report on open recommendations and is, therefore, now being closed.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to suspend further implementation of its system sharing policy until HCFA provides continual oversight and direction of conversion activities to minimize disruption and ensure that Medicare processing goals are met. |
HHS disagreed with the recommendation. The Department stated that it was pleased with the success of the shared systems initiative and had no desire to reverse course. This recommendation was included in the last annual report on open recommendations and is, therefore, now being closed.
|
| Department of Health and Human Services | The Secretary of Health and Human Services should direct the Administrator, HCFA, to suspend further implementation of its system sharing policy until HCFA develops a long-term strategic plan outlining the HCFA vision for Medicare claims processing and the interim steps needed to achieve this vision. Such a plan must address the use of technology in safeguarding Medicare funds and processing claims efficiently. |
HHS disagreed with the recommendation. The Department stated that it was pleased with the success of the shared systems initiative and had no desire to reverse course. This recommendation was included in the last annual report on open recommendations and is, therefore, now being closed.
|
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Topics
Electronic data processingClaims processingComputer matchingContract performanceCost effectiveness analysisHealth insurance cost controlMedical expense claimsMedicareService contractsData automation