United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1994-08-02 monographic deposited born digital GA 1.13:HEHS-94-171 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-94-171 P0b002ee180392311 f:he94171 DGPO 2010-08-12 2011-03-24 GAOREPORTS-HEHS-94-171 machine generated eng fdlp REPORT GAOREPORTS-HEHS-94-171 HEHS-94-171 Medical expense claims Claims processing Contract administration Cost control Contractor performance Competitive procurement Beneficiaries Contractor payments Insurance companies Evaluation methods Medicare Program National Performance Review HCFA Contractor Performance Evaluation Program Letter Report HEHS

Since 1966, the Health Care Financing Administration (HCFA) has awarded most contracts to process claims under Medicare parts A and B without competition, has renewed them annually, and has compensated contractors on a cost-reimbursement basis. Periodically, the Congress has directed HCFA to experiment with other types of contracts in an effort to reduce administrative costs. Earlier experiments had mixed results, but current experiments indicate that different types of contracts may reduce costs. The Congress is now considering a legislative proposal requiring HCFA to study the feasibility of making the contracting process more competitive. While HCFA's current authority provides opportunities to achieve administrative efficiencies, it may be useful for the Congress to direct HCFA to evaluate new approaches that could lead to a more competitive environment. Any changes, however, should avoid problems that have occurred in the past. The role that the Blue Cross and Blue Shield Association (the national trade association for independent Blues plans) plays in coordinating part A contracting activities with individual Blues plans may limit the need for HCFA resources to perform these activities. However, HCFA has not evaluated the Association's performance since 1989, even though HCFA paid the Association over $21 million during that period. In GAO's view, HCFA needs to regularly assess the Association's performance, just as it does for other contractors, to ensure that the Medicare program is being managed efficiently. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-94-171/html/GAOREPORTS-HEHS-94-171.htm GAO/HEHS-94-171 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-94-171 Letter Report GAO/HEHS-94-171; Medicare: HCFA's Contracting Authority for Processing Medicare Claims; Medical expense claims Claims processing Contract administration Cost control Contractor performance Competitive procurement Beneficiaries Contractor payments Insurance companies Evaluation methods Medicare Program National Performance Review HCFA Contractor Performance Evaluation Program Title 42 Section 1395h Title 42 Section 1395u 42 U.S.C. 1395h 42 U.S.C. 1395u