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 1999-06-11 monographic deposited born digital 25 p. GA 1.13:HEHS-99-124 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-124 P0b002ee18038f4f7 f:he99124 DGPO 2010-08-12 2011-03-23 GAOREPORTS-HEHS-99-124 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-124 HEHS-99-124 Veterans benefits Health insurance cost control Health care programs Claims settlement Veterans Insurance companies Patient care services Prices and pricing Health insurance Medical services rates Letter Report HEHS

The Department of Veterans Affairs (VA) used a sound methodology to replace its cost-based system with a charge-based system that sets charges at the 80th percentile level and better resembles market prices for thousands of health procedures and hundreds of diagnosis groups. VA expects higher revenues from insurers as a result but it lacks adequate data to estimate the effect of reasonable charges on its revenue and corresponding insurer cost. However, reasonable charges will not affect veterans' copayment and per diem obligations. Reasonable charges are expected to play a key role in VA's plans to expand and improve veterans' health care without increasing appropriations through fiscal year 2002, but factors that could limit the contribution that reasonable charges make to its revenue collections include VA's inability to collect routinely from health maintenance organizations and Medicare and its overcoming past collection problems. To the extent that VA's method will set some reasonable charges below insurers' usual payments, VA will collect less than other providers. VA does not have standardized procedures to ensure that insurers' payments are appropriate if less than reasonable charges. GAO recommends (1) monitoring reasonable charges and identifying those that should be increased to conform with local market prices and (2) verifying the appropriateness of insurers' payments when they are less than VA's reasonable charge. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-124/html/GAOREPORTS-HEHS-99-124.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-124/pdf/GAOREPORTS-HEHS-99-124.pdf GAO/HEHS-99-124 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-124 Letter Report GAO/HEHS-99-124; VA Health Care: Third-Party Charges Based on Sound; Veterans benefits Health insurance cost control Health care programs Claims settlement Veterans Insurance companies Patient care services Prices and pricing Health insurance Medical services rates Title 38 Section 1729(c)(2)(B) Title 38 Section 1729(c)(2)(C) 38 U.S.C. 1729(c)(2)(B) 38 U.S.C. 1729(c)(2)(C) Public Law 99-272 Public Law 101-508