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HRD-82-74 1 (1982-05-19)

handle is hein.gao/gaobabdhn0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 20548 HUMAN RESOURCXS DIVISIONRESTRICT-7 by b;eC , .MY1,18 B-207365 MAY 19,1982 The Honorable Bill Archer REASDHII NHII House of Representatives 118487 Dear Mr. Archer: Subject: Delays in Processing Medicare Beneficiary Claims in Texas (GAO/HRD-82-74) On October 6, 1981, you requested that we make an indepth review of the processing of Medicare claims in Texas. You ex- pressed concern about unusual and serious delays experienced by Medicare beneficiaries and their physicians in getting Medicare claims processed and paid in an accurate and timely manner. Our review confirmed your concerns. These delays resulted from a substantial backlog of unprocessed claims which developed in mid-1981, when Texas Blue Cross and Blue Shield, the Medicare intermediary and carrier in Texas, converted to a new computer system for processing Medicare claims. There seems to be no question that these delays resulted in financial hardships to beneficiaries and providers; the extent of these hardships would vary on a case-by-case basis. Our followup on individual cases was limited to the 17 provider and beneficiary complaints we received from your Houston office. Two of these complaints did not include sufficient information for Texas Blue Cross and Blue Shield officials to identify the claims in question. The claims identified in the other 15 complaints had been paid or otherwise disposed of by the end of December 1981, as shown by the information provided to your office under separate cover. However, the processing times ranged from about 1 to 10 months, with the typical processing time being about 6 months. 1/ For all but one of these claims, Blue Cross and Blue Shield officials attributed the processing delays to the problems experienced in converting to the new computer system. One complaint involved delays resulting from lost checks. 1/As a basis for comparison, under Medicare's performance standards over 90 percent of the claims should be processed within I month. (106218) ej222 Q(~ 7

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