Patients First: A 21st Century Promise to Ensure Quality and Affordable Health Coverage : Joint Hearing Before the Subcommittee on Health and the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, House of Representatives, One Hundred Seventh Congress, First Session, June 28, 2001, Volume 4 |
From inside the book
Results 1-3 of 3
Page 68
... clinical workgroups " as one of the " other duties " of contractor medical directors . These CMD workgroups apparently meet periodically , yet neither the agenda nor the minutes of these meetings are published publicly , nor do we know ...
... clinical workgroups " as one of the " other duties " of contractor medical directors . These CMD workgroups apparently meet periodically , yet neither the agenda nor the minutes of these meetings are published publicly , nor do we know ...
Page 69
... Clinical Standards and Quality , CMS re September 25 , 1998 , Open Town Hall Meeting To Discuss the Medicare Coverage Process ] SOLUTION Again , MDMA appreciates CMS's ongoing efforts to modernize the local Medicare coverage ...
... Clinical Standards and Quality , CMS re September 25 , 1998 , Open Town Hall Meeting To Discuss the Medicare Coverage Process ] SOLUTION Again , MDMA appreciates CMS's ongoing efforts to modernize the local Medicare coverage ...
Page 71
... clinical laboratory , outpatient physical and occupational therapy services , and durable medical equipment and supplies . To process and pay claims for services in the traditional program , CMS has 49 contracts with insurance companies ...
... clinical laboratory , outpatient physical and occupational therapy services , and durable medical equipment and supplies . To process and pay claims for services in the traditional program , CMS has 49 contracts with insurance companies ...
Other editions - View all
Common terms and phrases
agency ARONOVITZ beneficiaries and providers benefits BILIRAKIS Blue Cross Blue Cross Blue CAPPS carriers and intermediaries Centers for Medicare Chairman changes Chiplin claims administration contractors claims processing CMD workgroups committee CONGRE CONGRESS THE LIBRARY contracting authority Contracting Reform Proposal contractor operations costs Cross and Blue Cross/Blue Shield develop durable medical equipment efficient ensure entities federal Federal Acquisition Regulation fiscal intermediaries flexibility full and open functional contracting funding GAO-01-1046R Medicare Contracting GREENWOOD HCFA health insurers implementation improve incentives integrity intermediaries and carriers issue legislation LIBRARY OF CONGRESS LMRP local coverage determinations Mangano MDMA Medi mediaries Medicaid Medicaid Services Medicare beneficiaries Medicare claims administration Medicare Contracting Reform Medicare contractors Medicare coverage Medicare program Medicare's ment Michael Bilirakis million open competition payment program safeguard providers and beneficiaries regulations reimburse requirements SCULLY Secretary SEROTA Social Security Act Subcommittee terminate testimony Thank tion tractors
Popular passages
Page 48 - MIP activities. As an example, many of the frontend computer edits (eg, preventing duplicate payments and detecting suspicious claims) are funded through program management. Inadequate funding impacts different functions at different times, but always disrupts the integration of all the functional components needed to "get things right the first time.
Page 15 - ... altering documents and falsifying statements that specific work was performed In some cases, contractors prepared bogus documents to falsely demonstrate superior performance for which Medicare rewarded them with bonuses and additional contracts. In other examples, contractors adjusted their claims processing so that system edits designed to prevent inappropriate payments were turned off, resulting in misspent Medicare Trust Fund dollars. We have also encountered problems associated with...
Page 47 - Shield Plans serve as Part A Fiscal Intermediaries (FIs) and/ or Part B carriers and collectively process most Medicare claims. Blue Cross and Blue Shield Medicare contractors are proud of their role as Medicare administrators. While workloads have soared, operating costs — on a unit cost basis — have declined about two-thirds from 1975 to 2001. In fact, contractors' administrative costs represent less than 1 percent of total Medicare benefits. Few government expenditures produce the documented,...
Page 47 - During the early to mid-1990s, reductions in funding concurrent with increases in workload seriously eroded contractors' ability to fight fraud and abuse. Between 1989 and 2000, the number of Medicare claims climbed almost 70 percent to over 800 million, while payment review resources grew less than 11 percent. As a result...
Page 46 - Medicare and respond to approximately 40 million inquiries annually. 3. Handling Hearings and Appeals: Beneficiaries and providers are entitled by law to appeal the initial payment determination made by carriers and FIs. These contractors handle over 7.4 million annual hearings and appeals. 4. Special Initiatives to Fight Medicare Fraud, Waste, and Abuse: All contractors have separate fraud and abuse departments dedicated to assuring that Medicare payments are made properly. According to the Department...
Page 46 - FY 2001, it is estimated that contractors will process over 900 million claims, more than 3.5 million every working day. 2. Providing Beneficiary and Provider Customer Services: Contractors are the main points of routine contact with Medicare for both beneficiaries and providers. Contractors educate beneficiaries and providers about Medicare and respond to approximately 40 million inquiries annually.
Page 18 - For purposes of this part, the term "carrier" means— (1) with respect to providers of services and other persons, a voluntary association, corporation, partnership, or other nongovernmental organization which is lawfully engaged in providing, paying for, or reimbursing the cost of, health services under group insurance policies or contracts, medical or hospital service agreements, membership or subscription contracts, or similar group arrangements, in consideration of premiums or other periodic...
Page 47 - Thanks to this new funding mechanism, Medicare contractors have been able to improve their efforts to reduce the amount of fraud, waste, and abuse in the Medicare program. Contractors' enhanced anti-fraud and abuse efforts due to MIP funding contributed to the significant decline in improper claims and documentation submission by providers. The OIG audit of FY 2000 claims estimated that improper Medicare payments had dropped to $11.9 billion, or about 6.8 percent of the $173.6 billion in Medicare...
Page 46 - Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration, which, during fiscal year 2000, was responsible for processing more than $200 billion in Medicare expenditures.