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HRD-81-126 1 (1981-09-03)

handle is hein.gao/gaobabcmh0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE A Z,/ WASHINGTON, D.C. 20548 HUMAN RESOURCES DIVISION u>,;,,raiit SEPTEMBER 3, 1981 B -200144 The Honorable Lawton Chiles RELEASEDI United States Senate I 1 I111 Dear Senator Chiles: 116521 Subject: IMore Action Needed to Reduce Beneficiary Underpayments[ (HRD-8 1- 126) This report was prepared at the request of your office and represents the results of our follow-on work to an earlier report also prepared at your request. That report to the Secretary of Health and Human Services (HHS), dated October 22, 1980, and en- titled Reasonable Charge Reductions Under Part B of Medicare, addressed four areas where beneficiaries were subject to inequit- able out-of-pocket costs for services covered by Medicare. We made several recommendations to the Secretary of HHS aimed at improving the equity and accuracy of reimbursements to beneficiaries on un- assigned claims. When doctors do not accept assignment (unassigned claim), beneficiaries are liable for the difference between what the doctors charge and what Medicare allows as the reasonable charge. During 1979, the beneficiaries' liability for the differ- ences between the submitted and allowed charges on unassigned claims was about $1.1 billion. This report contains another recommendation to the Secretary of HHS which we believe will provide further safeguards for pre- venting underpayments to beneficiaries for services covered by Medicare. Claims that are subject to relatively large reasonable charge reductions often involve underpayments which go undetected because of poor claims review. The Health Care Financing Adminis- tration (HCFA)--as part of its Contractor Performance Evaluation program and related Carrier Quality Assurance program l/--should 1/The quality assurance program is designed to measure the accuracy and overall quality of claims processing under Part B of Medicare. To achieve this objective, a sampling of actual claims that have been processed are reviewed by both carrier and HCFA quality assurance reviewers. (106194)

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