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089021 1 (1978-01-11)

handle is hein.gao/gaobacval0001 and id is 1 raw text is: n 1UNITED STATES GENERAL ACCOUNTING OFFICE (I WASHINGTON, D C 20548 HUMAN RESOURCES X DIVISION Mr. Robert A. Derzon, Administrator C&<A Health Care Financing Administration Department of Health, Education, and Welfare Dear Mr Derzon We have recently completed a survey of Medicare carriers' use of prepayment computer edits to prevent duplicate payments. 2. Medicare Bureau statistics show that carriers detected about $360 -- million in duplicate claims during fiscal year 1976 using prepayment edits However, during that year, an additional $1 6 million in duplicate claims were found during postpayment reviews and payees voluntarily returned about $2 million in duplicate payments which had not been detected by the carriers Information obtained from 28 carriers in five Medicare Bureau regions showed that most of the carriers use prepayment computer edits which do not fully comply with the Bureau requirements. Our tests at one of the carriers showed that this has resulted in duplicate payments Although we have not determined the total number or amount of duplicate payments involved, they could be significant for those carriers whose edits differ considerably from the Bureau's requirements Additionally, some carriers have edits that are probably resulting in unnecessary manual reviews. Our survey also shows that the Bureau needs to change its requirements for the computer edits used to automatically deny duplicate claims to include matches with claims still in process This change would reduce the number of manual reviews and also reduce the potential for errors that might be made in the manual review process These matters are discussed in gifeater Aetail below.

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