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MWD-76-92 1 (1976-02-02)

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          RELEASED

REPORT OF THE

COMPTROLLER GENERAL

OF THE UNITED STATES


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Reasonable Charge Reductions And
Related Matters Under Part B

Of M ed ica re



Social Security Administration

Department of Health, Education, and Welfare





Blue Cross-Blue Shield of Greater New York
reduced about two-thirds of the Medicare
claims it processed during fiscal year 1974.
The reductions were made because charges
exceeded reasonable charges which under pro-
gram regulations are based on charge data 6-
to 30-months old. Incorrect coding of claims
contributed to the reasonable charge reduc-
tions. Relatively few claims were involved in
the appeals process; however, a large portion
of claims involved in the appeals process were
reversed in favor of the claimants.


MWD-76-92


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