Medicare Contracting Reform: CMS's Plan Has Gaps and Its Anticipated Savings Are Uncertain
DIANE Publishing, Nov 1, 2005 - 63 pages
The Medicare Prescription Drug, Improvement, & Modernization Act of 2003 (MMA) significantly reformed contracting for the administration of claims for Part A, Medicare's hospital insurance, & Part B, which covers outpatient services such as physicians' care. The MMA required the Centers for Medicare & Medicaid Services to conduct open competition for its claims administration contracts & to transfer the work to Medicare administration contractors by Oct. 2011. This report reviewed the extent to which: (1) the plan provides an appropriate framework for implementing Medicare contracting reform; & (2) the plan's cost & savings estimates are sound enough to support decisions on implementation. Charts & tables.
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A/B MAC addition agency agency's Appendix assumptions award BCBS beneficiaries and providers Centers for Medicare claims administration contractors claims workload CMS officials CMS plans CMS staff CMS will select CMS's contracting reform CMS's Estimates competition completed conduct contracting reform implementation contracting reform plan contractor performance coordinate cost and savings cost estimate criteria current contractors Department of Health developed DME MACs documents draft durable medical equipment evaluation functional contractors GAOConcern Government Accountability Office Health and Human HH MACs HIGLAS HlGLAS home health Human Services implementation schedule implementing contracting reform improper payments improve initiatives Jurisdictional Map MAC implementation MAC jurisdictions MAC procurements Medicaid Services medical reviews Medicare & Medicaid Medicare administrative contractors Medicare claims administration Medicare contracting reform Medicare fee-for-service Medicare Prescription Drug Medicare program million mitigation operational orthotics potential PSCs quality improvement organizations Report to Congress request for proposals savings estimates start-up cycle strategy workload transitions
Page 39 - We will also make copies available to others on request. In addition, the report will be available at no charge on GAO's Web site at http://www.gao.gov. If you or your staffs have any questions about this report, please contact me at (202) 512-7101 or BascettaC@gao.gov.
Page 47 - The Department of Health and Human Services (HHS) appreciates the opportunity to comment on the US Government Accountability Office's (GAO) draft report. General Comments The growth of concierge care has been the subject of some debate in the past few years.
Page 46 - Director, Health Care US Government Accountability Office Washington, DC 20548 Dear Ms. Aronovitz: Enclosed are the Department's comments on the US Government Accountability Office's (GAO's) draft report entitled, "MEDICARE CONTRACTING REFORM: CMS's Plan Has Gaps and Its Anticipated Savings Are Uncertain
Page 42 - December 8, 2003, as part of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).
Page 3 - I contains a more detailed discussion of our scope and methodology.) We performed our work between December 2000 and December 2001 in accordance with generally accepted government auditing standards. 2 Hereinafter, the term "states" will refer collectively to the 50 states plus the District of Columbia and Puerto Rico.
Page 5 - Eligible individuals can choose to enroll in part B and pay a monthly premium. Medicare part B services include physician and outpatient hospital services, diagnostic tests, mental health services, outpatient physical and occupational therapy, ambulance services, some home health services, durable medical equipment, prosthetics, orthotics, and medical supplies.
Page 6 - ... the full set of functions, except when the Congress gave specific authority to contract separately for a function. The Social Security Act also generally calls for the use of cost-based reimbursement contracts under which contractors are reimbursed for necessary and proper costs of carrying out Medicare activities, but does not expressly provide for profit. Furthermore, the Medicare statute...
Page 20 - ... Headquarters and Regional Office Oversight (GAO/HEHS-00-46, Mar. 23, 2000). Medicare: Program Safeguard Activities Expand, but Results Difficult to Measure (GAO/HEHS-99-165, Aug. 4, 1999). Medicare Contractors: Despite Its Efforts, HCFA Cannot Assure Their Effectiveness or Integrity (GAO/HEHS-99-115, July 14, 1999). Medicare: Improprieties by Contractors Compromised Medicare Program Integrity (GAO/OSI-99-7, July 14, 1999). Medicare: Fraud and Abuse Control Pose a Continuing Challenge (GAO/HEHS-98-215R,...