Defense Health Care. Reimbursement of Hospitals Not Meeting CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) Copayment Requirements.
Abstract
Public Law 100-180, enacted on December 4, 1987, required GAO to review the practices under various insurance plans and federal programs with respect to payments for charges for medical services to hospitals that do not impose a legal obligation on patients to pay for such services. GAO was also required to evaluate CHAMPUS practices regarding such payments and to make recommendations it considered appropriate for changing these practices. CHAMPUS beneficiaries are required to pay legislatively established deductible and coinsurance amounts (copayments) for services they receive from civilian health care providers. The providers are responsible for collecting the copayments. CHAMPUS does not routinely monitor the collection of these copayments, but when it becomes aware that a provider waives patient copayments, it denies the provider's claim for reimbursement. Of the plans and programs GAO reviewed, only CHAMPUS and Medicare were aware of dealing with hospitals that did not bill patients for copayments. CHAMPUS denies reimbursement to such hospitals, while Medicare reimburses them. A major concern when a provider waives the patient's copayment is that the provider will increase the amount charged the insurance company to recoup lost revenues. Medicare officials believed that its prospective payment system for hospitals protected the program from paying such increased charges. Keywords: Civilian Health and Medical Program of the Uniformed Services.
Document Details
- Document Type
- Technical Report
- Publication Date
- Jun 01, 1988
- Accession Number
- ADA197876
Entities
Organizations
- United States Government Accountability Office