Medicare: Better Controls Needed for Peer Review Organizations' Evaluations.
Abstract
This report, issued at the Subcommittee's request, discusses the Health Care Financing Administration's (HCFA'S) evaluation of Peer Review Organizations' performance during the 1984-86 contract period. It also discusses HCFA'S process for determining program funding for the 1986-88 contract period. The report contains recommendations to the Secretary of Health and Human Services. Professional Review Organizations (PROS) contract with the Medicare program to review the necessity, appropriateness, and quality of inpatient hospital services received by the program's beneficiaries. From February through July 1986, the Department of Health and Human Services' (HHS'S) Health Care Financing Administration (HCFA) evaluated the PROS' performance under their contracts to determine whether the contracts, awarded for a 2-year period, should be renewed on a noncompetitive basis or whether a competition should be renewed on a noncompetitive basis or whether a competition should be held. As a result of the evaluations, HCFA was requiring competition for about half of the PRO contracts. Based on a concern that the high nonrenewal rate indicated problems either with some PROS or with HCFA'S management of the program, the Chairman and Ranking Minority Member of the Subcommittee on Health, Senate Committee on Finance, requested that GAO assess (1) HCFA'S PRO evaluation methodology and (2) the adequacy of HCFA'S routine monitoring of the PROS for identifying performance problems. In addition, GAO was asked to determine how HCFA decided on the funding level for the new contracts.
Document Details
- Document Type
- Technical Report
- Publication Date
- Oct 01, 1987
- Accession Number
- ADA187585
Entities
Organizations
- United States Government Accountability Office