United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2001-09-25 monographic deposited born digital GA 1.13:GAO-01-1141T https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-1141T P0b002ee180396bfd f:d011141t DGPO 2010-08-12 2011-03-28 GAOREPORTS-GAO-01-1141T machine generated eng fdlp REPORT GAOREPORTS-GAO-01-1141T GAO-01-1141T Billing procedures Health care programs Managed health care Claims processing Medicare Program Testimony A01784 Complete, accurate, and timely communication of program information is necessary to help Medicare providers comply with program requirements and appropriately bill for their services. Information provided to physicians about billing and payment policies is often incomplete, confusing, out of date, or even incorrect. GAO found that the rules governing Centers for Medicare and Medicaid Services (CMS) contracts with its claims processors lack incentives for efficient operations. Medicare contractors are chosen without full and open competition from among health insurance companies, rather from a broad universe of potential qualified entities, and CMS almost always uses cost-only contracts, which pay contractors for costs incurred but generally do not offer any type of performance incentives. To improve Medicare contractors' provider communications, CMS must develop a more centralized and coordinated approach consistent with the provisions of the Medicare Regulatory and Contracting Reform Act (MRCRA) of 2001. MRCRA would require that CMS (1) centrally coordinate contractors' provider education activities, (2) establish communications performance standards, (3) appoint a Medicare Provider Ombudsman, and (4) create a demonstration program to offer technical assistance to small providers. MRCRA would also broaden CMS authority so that various types of contractors would be able to compete for claims administration contracts and their payment would reflect the quality of the services they provide. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-01-1141T/html/GAOREPORTS-GAO-01-1141T.htm GAO-01-1141T https://www.govinfo.gov/app/details/GAOREPORTS-GAO-01-1141T Testimony GAO-01-1141T; Medicare: Improvements Needed in Provider Communications and Contracting Procedures; Billing procedures Health care programs Managed health care Claims processing Medicare Program