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HRD-82-30 1 (1981-12-16)

handle is hein.gao/gaobabcti0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE K #!' JWASHINGTON, D.C. 20548 HUMAN RESOURCES DIVISION December 16, 1981 Dr. Carolyne Davis, Administrator Health Care Financing Administration Department of Health and Human Services 117121 Washington, D. C. 20201 Dear Dr. Davis: Subject: J Guidance and Information Needed on the Use of ..Xachine Readable Claims Under Medicare and Medicaid __ (HRD-82-30) We surveyed the extent that Medicare and Medicaid providers (1) use machine readable claims I/ and billing service companies and (2) the implications of their use on claims processing agent (Medicare contractors and Medicaid agencies or fiscal agents) operations such as administrative costs, utilization and quality control reviews, and reimbursement deterrinations. We were also interested in whither there were any potential conflicts of interest between claims processing agents and billing service companies. The information we obtained shows that the Health Care Financing Administration (HCFA) needs to improve ccntrols over machine read- able claim systems in use under Medicaid and obtain information so that it can develop policies for implementing the most effective and efficient systems for using such claims. SCOPE AND METHODOLOGY We performed most of the survey work in HCFA Region IV (Atlanta). Five of the nine Medicare carrfers in the region receive and process machine readable claims and all eight State Medicaid agencies or their fiscal agents receive and process such claims. We also obtained limited information on the use of machine readable claims in HCFA Regions V (Chicago), VI (Dallas), and IX (San Francisco). I/As used in this report, machine readable claims refers to those systems using electronic media such as magnetic tape and computer terminals to input claim data. It does not include optical char- acter reader systems because, in these systems, providers or billing companies do not input data to the claim processing agents elec- tronically; they use paper claim forms. (106200)

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