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NCJ Number: 66309 Add to Shopping cart Find in a Library
Title: MORE CAN BE DONE TO ACHIEVE GREATER EFFICIENCY IN CONTRACTING FOR MEDICARE CLAIMS PROCESSING
Author(s): ANON
Corporate Author: US Comptroller General
United States of America
Date Published: 1979
Page Count: 220
Sponsoring Agency: Azimuth Inc.
Fairmont, WV 26554
US Comptroller General
Washington, DC 20548
Sale Source: Azimuth Inc.
1000 Technology Drive, Suite 3120
Fairmont, WV 26554
United States of America
Language: English
Country: United States of America
Annotation: THIS STUDY EXAMINED THE CLAIMS PROCESSING SYSTEM UNDER MEDICARE AND SUGGESTS SEVERAL MODIFICATIONS TO IMPROVE EFFICIENCY AND REDUCE COSTS.
Abstract: MOST MEDICARE BENEFITS ARE ADMINISTERED BY THE DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE (HEW) THROUGH REIMBURSABLE CONTRACTS WITH PRIVATE INSURANCE COMPANIES. CONTRACTORS WHO PAY BILLS FOR HOSPITAL, NURSING HOME, AND HOME HEALTH CARE SERVICES ARE TERMED 'INTERMEDIARIES,' WHILE THOSE WHO PAY DOCTORS AND SUPPLIERS ARE CALLED 'CARRIERS.' THE GAO STUDY FOUND THAT SUBSTANTIAL SAVINGS COULD BE REALIZED BY DISTRIBUTING LARGER WORKLOADS TO FEWER CONTRACTORS AND BY CONSOLIDATING INTERMEDIARIES AND CARRIERS INTO AN INTEGRATED CLAIMS PROCESSING SYSTEM. ALTHOUGH PRELIMINARY ESTIMATES INDICATED THAT A CHANGE TO COMPETITIVE FIXED-PRICE CONTRACTING WOULD REDUCE ADMINISTRATIVE COSTS, THE EFFECTS ON QUALITY OF SERVICES ARE UNKNOWN. ALL CONTRACTS CONTAIN SPECIFIC PERFORMANCE STANDARDS SO THAT CONTRACTORS WHO PERFORM POORLY COULD BE TERMINATED. EXPERIMENTS SHOULD BE CONDUCTED ON INCENTIVE CONTRACTS. IN EXAMINING CLAIMS PROCESSED BY THE TRAVELERS INSURANCE COMPANY FOR THE RAILROAD RETIREMENT BOARD, GAO FOUND THIS CONTRACT TO BE UNECONOMICAL AND RECOMMENDED ITS TERMINATION. ADMINISTRATIVE COSTS AND PAYROLL DELAYS COULD BE REDUCED IF CONTRACTORS USED INTEGRATED SYSTEMS TO PROCESS CROSSOVER FOR WHICH MEDICARE AND MEDICAID AND JOINTLY LIABLE. GAO ALSO SUGGESTED THAT HEW BE GIVEN CONTINGENCY AUTHORITY TO TRY COMPETIVE FIXED-PRICE CONTRACTING RATHER THAN NEW LEGISLATION. THE APPENDIXES CONTAIN INFORMATION ON THE HISTORY OF MEDICARE CONTRACTING, MEDICARE'S COMPETITIVE FIXED-PRICE EXPERIMENTS, CARRIER AND INTERMEDIATE OPERATORS, AND CORRESPONDENCE CONCERNING THE REPORT'S RECOMMENDATIONS. (MJM)
Index Term(s): Government contracting; Medicaid/Medicare fraud; Medical and dental services; Medical costs; US Department of Health, Education, and Welfare; US Government Accountability Office (GAO)
Note: THERE IS A CHARGE FOR MORE THAN ONE COPY. REPORT TO THE CONGRESS OF THE UNITED STATES BY THE COMPTROLLER GENERAL
To cite this abstract, use the following link:
http://www.ncjrs.gov/App/publications/abstract.aspx?ID=66309

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