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HRD-84-88 1 (1984-08-17)

handle is hein.gao/gaobabnll0001 and id is 1 raw text is: UNITED STATES GENERAL ACCOUNTING OFFICE WASHINGTON, D.C. 2054 HUMAN RE80URCM August 17, 1984 DIVIION Carolyne K. Davis, Ph.D. Administrator Health Care Financing Administration 25007 Department of Health and Human Services Dear Dr. Davis: Subject: Proposal to Improve Identification and Collection of Medicare Part B Duplicate Payments (GAO/HRD-84-88) Duplicate payments are one of the principal causes of overpayments in Medicare Part B. Our work at selected Medicare claims processing contractors showed that computer screeninq of paid claims can be a cost beneficial way to identify duplicate payments so that recovery action can be taken. This report summarizes our work and proposes that the carriers screen their paid claims annually for duplicate payments until the process ceases to be cost beneficial. BACKGROUND Medicare is a health insurance program which covers (1) most Americans who are age 65 or older and (2) certain individuals under 65 who are disabled or who have chronic kidney disease. The program is authorized under title XVIII of the Social Security Act (42 U.S.C. 1395) and provides protection under two parts. Part A covers the services of institutional health care providers. Part B covers physician services, outpatient hospital care, and other medical and health services. Part B benefit payments for fiscal year 1983 were $17.5 billion. This report deals only with part B claims. The Health Care Financing Administration (HCFA) administers part B with the assistance of 49 contractors--called carriers. The carriers process and pay part B claims, which can be submitted by either the providers of medical services or the beneficiaries who receive them. Some claims list services which have been billed to the carrier previously. HCFA requires carriers to have prepayment controls to prevent paying for the same medical services more than once. Generally, information describing each medical service is coded by carrier personnel and entered in the carrier's computer system as a line item. The computer compares (106238)

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