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 1996-08-16 monographic deposited born digital 21 p. GA 1.13:HEHS-96-145 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-96-145 P0b002ee180373c28 f:he96145 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-96-145 machine generated eng fdlp REPORT GAOREPORTS-HEHS-96-145 HEHS-96-145 Health care programs Health insurance cost control Overpayments Billing procedures Therapy Nursing homes Medical services rates Health care services Medical expense claims Medicare Program HCFA Common Procedure Coding System Letter Report HEHS

Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) progress in curbing overbilling for occupational speech and physical therapy services.<p/>GAO found that: (1) therapy charges billed to Medicare by skilled nursing facilities (SNF) and rehabilitation agencies have more than doubled since 1990; (2) some providers are exploiting weaknesses in Medicare's payment system, since HCFA places no absolute dollar limit on Medicare reimbursements for occupational and speech therapy; (3) HCFA is unable to determine whether a claim is reasonable prior to payment, since SNF are not required to specify how much therapy time they are billing for specific services; (4) HCFA has taken a number of interim actions to curb inappropriate charges, such as implementing salary equivalency guidelines for those SNF providing occupational and speech therapy services; and (5) HCFA officials have emphasized the importance of more systematic legislative approaches, such as unified billing, to solve the problem of therapy overcharges. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-96-145/html/GAOREPORTS-HEHS-96-145.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-96-145/pdf/GAOREPORTS-HEHS-96-145.pdf GAO/HEHS-96-145 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-96-145 Letter Report GAO/HEHS-96-145; Medicare: Early Resolution of Overcharges for Therapy in Nursing Homes is Unlikely; Health care programs Health insurance cost control Overpayments Billing procedures Therapy Nursing homes Medical services rates Health care services Medical expense claims Medicare Program HCFA Common Procedure Coding System Title 5 Section 551 5 U.S.C. 551 Title 42 Section 1395i-3(b) Title 42 Section 1396r(b) 42 U.S.C. 1395i-3(b) 42 U.S.C. 1396r(b)