Audit finds billions in improper pay: Medicare's 'confusing and complex' rules may be to blame

Article Abstract:

The first comprehensive review of the Health Care Financing Administration by the Dept. of Health and Human Services' Office of the Inspector General found that Medicare records in 1996 included $23 billion in improper payments. The study showed 47% of those payments lacked proper documentation, and 37% were for unnecessary treatments. Inspector General June Gibbs Brown pointed out that the system of reimbursement rules and volume of claims may be responsible for the errors.

Accounting and auditing, Statistics, Medical care, Cost of, Health care costs

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Can HCFA meet challenges of changing Medicare program?

Article Abstract:

The General Accounting Office is concerned whether the Health Care Financing Administration is capable of handling its new responsibilities. HCFA is still settling after a sizeable internal restructuring, and has had staff turnover of nearly 40% during 1993-1998. One of HCFA's new duties is oversight of Medicare managed care, a market expected to hit 17 million by 2008.

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AMA, HCFA both work to improve Medicare E&M rules

Article Abstract:

Medicare documentation guidelines developed by the US Health Care Financing Administration and the American Medical Association for evaluation and management services will become mandatory in Jul 1998. Documentation must be a byproduct and function of clinical care if the guidelines are going to work. A better auditing system must also be implemented.

American Medical Association, Powers and duties, Insurance claims adjustment

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