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089405 1 (1972-03-26)

handle is hein.gao/gaobacvjs0001 and id is 1 raw text is: [0)' S21 CIVIL DIVISION UJN'TiE) S*'.etAT. Gtir4! ACCOUwrmMf, 0H-FiCE ~. b'972 tsar ENy Ball: c)(.0 \ZAP_ foe7rdr1 The General Accocunting Office has reviaged the procedures used by Wasbingtor. 1PIyicians 1. Serv~ice (wUS) for proce~ssing and payIng claimis for physiciasns! servicso pyovi~ed 'unr~ t ±s Supplamantary !{eical Insurance prograi--ax't B cae IAS is th h~dicare carrier for the- State of Wasiington and uwas a system of 20 separate and autonomous corporation s--nmodica3. sarv ice hoesn~-to process Vidicare claJIMIs. Our review, !shich waE dir~cted- toward an analysis of the effciency and effectiveness of this dcentra-4ed. qproach showed tat the IRPS system nay not be the nont a iiot and effective method of processing claims. W~e believe that 03 systax could be iproved by either con- solidating~ the activities TT the wqarb buroaus ox by using an alternate systemn for processing~ cairs. CARRBES' I E IN ?R-OCES$IN CDA__1 In February 1966, the Scotary of HLET entered into a contract wiith WPS to serve as the hiara arier Rox' th State of Tishington. I'bst ofr the claims pracess~g fanation wns ths WPS contrart was in. turn ssubcontracted to medical s2. riic brns Screams) Ahch act as Midicare oarriers in thsir ~eToosos eog raphical ares. W)PS serves as the eentkal coordinating body for' thet Bureauts and does not prpcess any NEdicare part B claimus. At tha time of our rte'jw, the Burnaue v~ere uaing four different systams for processing part B claims in the Stato of Washington. Three of the Buraaus, including t>.e two largest which in fiscal years 1970 and 1971 proceseed about 52 percent of tha 0~dicare part B claims in the State, did Mhir claims processing in-houe. The other 17, H~ich. processed about 45 percent of the clais, had further suboontrictai with Computer Services, Inc., (GSi) to do Part of thiell claimns processi~ng. IRTMEMS WIh fl DCNRALIZEDSS-M The d&centralized o z-LiationaJ struoturs) usEd 'jr ITS iLs not, in our opinion the' most efficint and efoctLva aylprach two doing a job which appears to havo a i potentlia2 a! or u'sin g ci ntralized automated pvccedares. Gar ravion of Social Snauxity ANinstration (SSA) records andi d inussiora Nrth SaL) &RU 6h~ awnd that Sah had recognized for scoie tina tht mioot of thai Bureaus were not processing

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