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HRD-81-12 1 (1980-10-22)

handle is hein.gao/gaobabbdt0001 and id is 1 raw text is: GAO United States General Accounting Office Human Resources WAshington. DC 20548 Division B-200144 OCTOBER 22, 1980 The Honorable Patricia Roberts Harris The Secretary of Health and Human Services Dear Mrs. Harris: 113625 Subject: &easonable Charge Reductions Under Part B of Medicarej(HRD-81-12) Pursuant to a request from Senator Lawton Chiles, Chair- man, Senate Special Committee on Aging, we examined whether Medicare beneficiaries are being properly reimbursed for doctors' bills under the program. The Committee is concerned that Part B of the Medicare program--which primarily covers the cost of physician services--is paying an increasingly smaller portion of the elderly's total cost for physician services. There are two principal reasons for this. First, on the average the charges submitted by doctors are reduced by the program for payment purposes by about 20 percent because they do not meet Medi- care's reasonable charge criteria. Second, the percentage of claims where the program reimburses the beneficiary (un- assigned claims) rather than the doctor (assigned claims) has increased from about 35 percent (in the early years of Medicare) to about 50 percent. Where the program pays the beneficiary, he or she in turn is liable for the difference between the submitted charges and Medicare's reasonable charges in addition to the normal 20-percent coinsurance amounts. During fiscal year 1979, the beneficiaries' liability for the difference between submitted and allowed charges on unassigned claims was about $1.1 billion--an increase from $882 million in fiscal year 1978. In contrast, on assigned claims (where Medicare pays the physician) the physician agrees to accept (106181) /

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