Summary

In response to a congressional request, GAO reviewed selected issues related to: (1) the administration of the Medicare part B program in Ohio; (2) timeframes for paying approved beneficiaries; (3) the performance of the Medicare claims processing contractor in Ohio; and (4) the reinstatement of Medicare eligibility to individuals whose deaths had been erroneously reported to the Social Security Administration (SSA).

GAO found that the claims processing contractor's ability to process claims has been adversely affected by: (1) the conversion to a new computer system; (2) the conversion to a new medical procedure coding system; and (3) an increased volume of claims in fiscal year 1985. In 1984, the Health Care Financing Administration (HCFA) ranked the contractor 4th among 47 evaluated part B carriers even though it did not meet HCFA timeliness standards due to the implementation of its new computer system. GAO found that, in recent years, the carrier has: (1) decreased its claims processing costs; (2) consistently had an error rate better than national average; (3) improved the accessibility of its telephone service; (4) not lost claims, even though its backlog problem could give the appearance of lost claims; (5) advanced funds to Medicare providers on behalf of HCFA for which it has been reimbursed; and (6) distributed two directories of part B providers. Finally, GAO found that about 10,000 individuals are removed from the SSA master beneficiary record (MBR) and the HCFA master insurance record each year because they are presumed to be dead. GAO found that SSA can reinstate these individuals to its rolls and make SSA payments to them sooner than HCFA can reinstate them to the Medicare rolls because: (1) SSA can use special procedures to pay the individuals before the MBR is corrected; and (2) Medicare rolls cannot be updated until after the MBR is corrected.