Synopses & Reviews
Synopsis
Excerpt from Administration of the Medicare Program-Payment Safeguards: Hearing Before a Subcommittee of the Committee on Appropriations United States Senate One Hundred Third Congress First Session; Special Hearing
Medicare has to pay. Compared to 116 million claims for inpatient and outpatient hospital services, nonhospital claims are expected to total 630 million claims in 1994. This represents a 55-percent increase in such claims since 1989.
Despite the rising volume of claims, contractors' per-claim funding for payment safeguards has declined since 1989 by over 20 percent. The largest portion of con tractor safeguard funding pays for staff who develop payment controls, review claims, and investigate suspect providers. When claims volume increases but the number of safeguard staff remains constant or declines, contractor staff apply fewer or less stringent payment controls.
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