MEDICARE: Improvements Needed in Provider Communications and Contracting Procedures
GENERAL ACCOUNTING OFFICE WASHINGTON DC
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The operation of the Medicare program is extremely complex and requires close coordination between CMS and its contractors. CMS is an agency within HHS but has responsibilities for expenditures that are larger than those of most other federal depattments. Under Medicares fee-for-service system-which accounts for over 80 percent of program beneficiaries physicians, hospitals, and other providers submit claims to receive reimbursement for services they provide to Medicare beneficiaries. In fiscal year 2000, fee-for-service Medicare made payments of 176 billion to hundreds of thousands of providers who delivered services to over 32 million beneficiaries. About 50 Medicare claims administration contractors carry out the day-to day operations of the program and are responsible not only for paying claims but also for providing information and education to providers and beneficiaries that participate in Medicare. Contractors that process and pay part A claims i.e., for inpatient hospital, skilled nursing facility, hospice care, and certain home health services are known as fiscal intermediaries and those that administer part B claims i.e., for physician, outpatient hospital services, laboratory, and other services are known as carriers.
- Administration and Management
- Medicine and Medical Research
- Medical Facilities, Equipment and Supplies