Medicare

HCFA Can Reduce Paperwork Burden for Physicians and Their Patients Gao ID: HRD-90-86 June 20, 1990

Pursuant to a congressional request, GAO reviewed the claims process for Medicare physician services to determine whether: (1) opportunities exist to help providers submit more complete claims; (2) notices to beneficiaries explain claims decisions clearly; and (3) electronic services, such as electronic mail, could reduce paperwork.

GAO found that: (1) in 1989, providers and beneficiaries filed 45 million incomplete claim forms; (2) incomplete claim forms were more costly to process than complete claim forms; (3) service descriptions and provider names on benefit notices were vague; (4) mathematical calculations and explanations of beneficiary liability were difficult to understand; and (5) reasons for service denial were not sufficiently precise. GAO also found that: (1) the Health Care Financing Administration (HCFA) could make filing claims easier by using electronic technologies to automate the process; (2) electronic technologies would reduce Medicare administrative costs and alleviate providers' cost and paperwork; and (3) some contractors and commercial insurers had already developed systems to simplify the claims process and make electronic filing available to more providers.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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