Medicare secondary payer program: identifying beneficiaries with other insurance coverage is difficult : statement of Leslie G. Aronovitz, Associate Director, Health Financing Issues, Human Resources Division, before the Subcommittee on Regulation and Government Information, Committee on Governmental Affairs, United States Senate
Leslie G. Aronovitz, United States. General Accounting Office, United States. Congress. Senate. Committee on Governmental Affairs. Subcommittee on Regulation and Governmental Information
The Office, 1993 - Business & Economics - 6 pages
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1.5 million 35 million beneficiaries age with permanent assistance from insurance avoid paying claims backlog of mistaken better identify beneficiaries billions of dollars chase situation claims for covered clarifying the Medicare Common Working File companies and employers conjunction with overall Contractor backlogs costs by billions data match efforts have ranged employer-sponsored group health employers with self-insured feasibility of HCFA February 1992 report fiscal year 1992 HCFA obtaining MSP helps pay medical identify other insurers identify primary payers INSURANCE BEFORE CLAIMS insurance coverage Medicare beneficiaries Medicare claim form Medicare contractors Medicare helps pay Medicare program Medicare secondary payer Medicare the secondary million additional beneficiaries mistakenly paid claims MSP activities MSP provisions MSP questions obtaining MSP data pay and chase Pay Before Medicare primary insurers private insurance companies ranged from clarifying recover Medicare payments recover mistaken payments Recovered From Primary SECONDARY PAYER PROGRAM spouses with health U.S. General Accounting younger disabled beneficiaries
Page 1 - Concerned about the escalating costs in the Medicare program, the Congress made several statutory changes during the 1980s that also made Medicare the secondary payer to certain employer-sponsored group health insurance plans and to automobile and other liability insurance plans.
Page 4 - Contractor backlogs were first discussed in our February 1991 testimony. See Medicare: Millions in Potential Recoveries Not Being Sought by Contractors (GAO/T-HRD-91-8, Feb. 26, 1991). These findings were included in a February 1992 report. See Medicare: Over $1 Billion Should Be Recovered From Primary Insurers (GAO/HRD-92-52, Feb. 21, 1992.) be able to recover about $135 million in mistaken payments because its contractors did not send out demand letters for claims that expired in December 1991.
Page 3 - Medicare: More Hospital Costs Should Be Paid by Other Insurers (GAO/HRD-87-43, Jan. 29, 1987). Medicare: Incentives Needed to Assure Private Insurers Pay Before Medicare (GAO/HRD-8919, Nov. 29, 1988) All of these approaches attempt to identify the possibility of private insurance coverage-^-but only at one point in time. Because beneficiaries' employment status is fluid, information collected through these efforts can become obsolete.
Page 2 - Backlogs of mistakenly paid claims have exceeded $1 billion over the past several years. Also, a data match using records from several Federal agencies recently helped HCFA identify over a million additional beneficiaries who potentially have other health insurance. EFFORTS TO ASSURE BETTER IDENTIFICATION OF PRIVATE INSURANCE BEFORE CLAIMS ARE PAID Over the past several years, we have issued a number of reports on how well contractors performed the first of their MSP responsibilities — identifying...
Page 2 - Medicare beneficiaries — approximately 4 percent — have other insurance that is primary to Medicare. Nevertheless, because of the size of the Medicare program, the dollar value of Medicare claims subject to the MSP provisions is substantial.
Page 4 - HCFA that they had identified over 1.1 mUlion additional beneficiaries who had other insurance. Contractors had not yet researched these beneficiaries' claims to determine amounts paid by Medicare that may be the responsibility of other insurers. In our February 1992 report, we estimated that these contractors may have paid more than $1 billion in Medicare claims that are potentially recoverable from primary insurers. As of January 1, 1993, contractors needed to determine if Medicare mistakenly paid...