Follow-up Review on General Accounting Office Report, More Hospital Costs Should Be Paid by Other Insurers

EXECUTIVE SUMMARY:

In a prior report the General Accounting Office (GAO) made six recommendations to improve identification of other forms of insurance that should pay for Medicare beneficiaries' medical services before Medicare. Our follow-up review found that HHS has taken appropriate action on five of the recommendations with which it had agreed. Specifically, the Health Care Financing Administration (HCFA): increased Medicare secondary payer (MSP) savings goals for intermediaries and has increased the Contractor Performance Evaluation Program standards for MSP performance; established the MSP outreach program to improve hospital performance in primary payer billings; revised the Hospital Manual to require hospitals to obtain complete information on beneficiaries' other insurance sources; revised the regulations to extend the MSP provision of the law to all forms of no-fault insurance coverage; and resubmitted its earlier legislative proposal to require primary payers to notify HCFA about individuals who are enrolled in insurance programs to which Medicare is a secondary payer and to notify the Secretary about pending claims from Medicare beneficiaries.

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