More Can be Done to Achieve Greater Efficiency in Contracting for Medicare Claims Processing: Report to the CongressGeneral Accounting Office, 1979 - 220 halaman |
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administrative costs APPENDIX I APPENDIX area carriers awarded basis beneficiaries and providers benefit payments bills Blue Shield Buffalo Blue California carriers and intermediaries CHAMPUS Chicago Blue claims volume competitive fixed-price contracting Congress consolidating contractor performance cost contracts cost per claim cost reimbursement Cross and Blue crossover claims data processing developed economies of scale EDSF effective efficient Electronic Data Systems estimated evaluation experiments fiscal year 1978 fixed-price procurement HCFA hospital identified Illinois incentive contracting increase incremental costs Insurance Company legislation Medicaid Medicare Bureau Medicare claims Medicare contractors Medicare program ment misrouted claims Mutual of Omaha nationwide nomination process number of carriers operations percent performance standards physicians poor performers problems proposal Railroad Retirement Board recommendation reduce the number result RRB beneficiaries RRB claims processing Secretary of HEW selected single contractor subcontract termination territories Texas Blue tion Travelers Insurance Company unit cost utilization review York
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Halaman 137 - A benefit period starts on the date a beneficiary is first hospitalized and ends when the patient has been out of a hospital or skilled nursing facility for 60 consecutive days.6 There is a 60-day lifetime reserve after the 90-day limit is exceeded.
Halaman 165 - ... after reasonable notice and opportunity for hearing to the agency or organization, that (A) the agency or organization has failed substantially to carry out the agreement, or (B) the continuation of some or all of the functions provided for in the agreement with the agency or organization is disadvantageous or is inconsistent with the efficient administration of this part.
Halaman 4 - Act to provide inpatient and outpatient hospital services, rural health clinic services, laboratory and X-ray services, skilled nursing facility services, physicians' services, home health care, family planning services, and early and periodic screening and treatment of eligible persons.
Halaman 5 - Denver, administers the program under the policy guidance and operational direction of the Assistant Secretary of Defense (Health Affairs). OCHAMPUS contracts with fiscal agents, such as Blue Cross and Blue Shield plans and Mutual of Omaha, to process and pay claims.
Halaman 5 - The Office for the Civilian Health and Medical Program of the Uniformed Services (OCHAMPUS), located at Fitzsimons Army Medical Center near Denver, administers the program under the policy guidance and operational direction of the Assistant Secretary of Defense (Health Affairs).
Halaman 214 - The Equitable Life Assurance Society of the United States, 1285 Avenue of the Americas, New York, NY 10019 ; * Ferro & Co., 35 Congress Street, Boston, Mass.
Halaman 165 - ... intent has not been carried out in at least two respects. First, there has been no active policy of complete and indepth comparison of carrier performance followed by decisions to weed out the poorer carriers in favor of those who are efficient and economical. As indicated, variations in performance are so great as to make at least some terminations easily justified. Second, the performance of some carriers has been so poor that there is little question that their performance was 'inconsistent...
Halaman 12 - ... the feasibility of merging parts A and B under a single contractor and...
Halaman 2 - Disabled) covers hospital and post-hospital services. Part B (Supplementary Medical Insurance Benefits for the Aged and Disabled) covers physicians' services and various outpatient services.
Halaman 188 - Honorable Elmer B. Staats Comptroller General of the United States Washington, DC 20548 Dear Elmer: In response to the request contained in your letter of November 21, 1979, I have obtained the attached comments from Dale Church.