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HRD-84-40 1 (1984-02-13)

handle is hein.gao/gaobabngk0001 and id is 1 raw text is: 




                  UNITED STATES GENERAL ACCOUNTING OFFICE
  iWASHINGTON, D.C. 20548
                                  February 13, 1984
HUMAN RESOURCES
   DIVISION




   Carolyne K. Davis, PhD
   Administrator, Health Care Financing
     Administration
   Department of Health and Human Services

   Dear Dr. Davis:

        Subject: Analysis of Medicare Durable Medical Equipment
                  Claims in Georgia, Idaho, and Southern
                  California (GAO/HRD-84-40)

        We are in the process of analyzing reimbursement for
   Durable Medical Equipment (DME) at four Medicare carriers
   covering all or portions of five states.1 Our work was
   requested by the Chairman of the Senate Committee on Finance.
   Because of congressional, industry, and Health Care Financing
   Administration (HCFA) interest in the probable effects of the
   July 1982 HCFA instructions to its carriers regarding procedures
   for determining whether to reimburse for DME on a rental or a
   purchase basis, we have agreed to report to you periodically on
   our progress. The first such report (GAO/HRD-83-73, July 8,
   1983) covered our work at Kansas City Blue Shield as of June
   1983.

        This report covers our work completed as of November 1983
    at Equitable in Idaho, Occidental in southern California, and
    Prudential in Georgia. The work remaining to be done before our
    final report to the Senate Committee on Finance involves
    simulating the probable effects of various proposals for
    reimbursing for DME, such as the ones presented by the National
    Association of Medical Equipment Suppliers and New York Blue
    Shield. We will also be simulating the probable effects of
    various waiting periods before making a rent-purchase decision
    and of applying a reimbursement ceiling or cap on rentals. In
    addition, we are examining statistical samples of physicians'
    prescriptions for DME and medical necessity forms from Idaho and
    Georgia to determine whether the information contained on the


    iThe carriers and States included in the review are:
    Prudential Insurance Company of North America (Georgia);
    Equitable Life Assurance Society of the United States
    (Idaho); Transamerica Occidental Life Insurance (southern
    California); and Blue Shield of Kansas City (Portions of
    Kansas and Missouri).


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