Download or read book Defense Health Care written by United States Accounting Office (GAO) and published by Createspace Independent Publishing Platform. This book was released on 2018-03-31 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: HEHS-95-142 Defense Health Care: Despite TRICARE Procurement Improvements, Problems Remain

Download or read book Defense Health Care written by United States. General Accounting Office and published by . This book was released on 1995 with total page 34 pages. Available in PDF, EPUB and Kindle. Book excerpt: As federal and state medical programs move to managed care, competitively bid contracting with private health care firms is being used more and more. In the federal sector, the Defense Department (DOD) has been a leader in the use of these contracts. As part of its introduction of a nationwide management health care program for the military, known as TRICARE, DOD has begun to award large, complex, competitively bid contracts to support and supplement the health care provided in military facilities. These five-year contracts are estimated to cost a total of about $17 billion. In response to concerns about DOD's difficulties with an early contract award covering California and Hawaii for which GAO sustained a protest of the award, this report reviews (1) procurement process problems identified by the bid protest experiences, (2) DOD's actions to improve and help ensure the fairness of the procurement process, and (3) what problems and concerns remain and whether further steps are needed.

Download or read book Defense Health Care written by United States. General Accounting Office. Health, Education, and Human Services Division and published by . This book was released on 1995 with total page 34 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Defense Health Care Despite TRICARE Procurement Improvements Problems Remain written by and published by . This book was released on 1995 with total page 35 pages. Available in PDF, EPUB and Kindle. Book excerpt: As federal and state medical programs move to managed care, competitively bid contracting with private health care companies is increasingly being used. Under the Medicaid program, states are using such contracts as part of their overall strategy to control rapidly escalating medical costs. In the federal sector, the Department of Defense (DOD) has been a leader in using these contracts. As part of its implementation of a nationwide managed health care program for military beneficiaries called TRICARE, DOD has begun to award large, complex, competitively bid contracts to supplement and support the health care provided in military medical facilities. These 5-year contracts are estimated to cost a total of about $17 billion.

Download or read book Defense Health Care written by Stephen P. Backhus and published by . This book was released on 1996 with total page 16 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Defense Health Care written by United States. General Accounting Office and published by . This book was released on 1996 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Defense Health Care written by United States. General Accounting Office and published by . This book was released on 1998 with total page 7 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pursuant to a congressional request, GAO responded to follow-up questions on its testimony on the Department of Defense (DOD) TRICARE Program. GAO noted that: (1) while some contractors and regions met their TRICARE enrollment goals, program-wide, DOD has fallen short of its enrollment expectations; (2) while DOD collects some data on beneficiary access to care, it does not use the data to measure TRICARE's performance in improving beneficiary access against DOD's standards; (3) it cannot report on how well the access standards are being met because the TRICARE Management Activity is not reporting data on the timeliness of appointments and it did not collect such data itself; (4) recent sustained protests against TRICARE contract awards indicate that some problems with bid evaluations continue; (5) DOD is simplifying the TRICARE procurement process while incorporating private-sector best practices; (6) since physicians continue to treat military beneficiaries and accept discounted Civilian Health and Medical Program of the Uniformed Services maximum allowable charge (CMAC) rates, it does not appear that the CMAC structure needs to be modified; (7) DOD is placing less reliance on resource sharing with its recently awarded TRICARE contracts and it plans not to include a resource sharing feature in its future TRICARE 3.0 contracts; and (8) because DOD has made such little progress with resource sharing and is phasing it out of future contracts, GAO expects that resource sharing will have a very limited impact on TRICARE's ability to contain costs and increase access.

Download or read book Defense Health Care written by Stephen P. Backhus and published by DIANE Publishing. This book was released on 1998 with total page 54 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Defense health care written by United States. General Accounting Office and published by . This book was released on 2003 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Testifying before Congress in 2002, military beneficiary groups and civilian managed care support contractors described problems with the processing of TRICARE claims for civilian-provided care. These problems included slow payments and procedures that made claims processing inefficient. The Bob Stump National Defense Authorization Act of 2003 required GAO to review improvements to TRICARE claims processing and continuing impediments to claims processing efficiency. Specifically, GAO describes (1) efforts to improve claims processing and changes in processing timeliness and (2) Department of Defense (DOD) procedures and data that continue to affect claims processing efficiency. To identify improvements to claims processing and impediments to processing efficiency, GAO analyzed 1999 and 2002 claims data for changes in processing timeliness. GAO also interviewed and analyzed claims processing documentation from DOD officials, managed care support contractors, and claims processors. In an effort to improve TRICARE claims processing, DOD and its managed care support (MCS) contractors have made changes that are designed to make it more efficient. First, they have jointly identified--and then eliminated or changed--certain DOD requirements they deemed inefficient and nonessential to accurate claims processing. For example, contractors are no longer required to hold claims with incomplete information and request the missing information from the provider or beneficiary. Instead, contractors may now return some claims with missing information. In another change, DOD eliminated preauthorization requirements for certain procedures and gave the MCS contractors more latitude for determining when preauthorizations are appropriate. To encourage providers to submit their claims electronically, DOD gave MCS contractors the authority to decide whether to adjudicate electronically submitted claims sooner than those submitted on paper. Further, MCS contractors have worked with their claims processors to implement new technologies for data input, claims routing, customer service, and claims submission. Finally, MCS contractors and their claims processors have improved the timeliness with which they process claims. In fiscal year 2002, claims processors processed over 97 percent of claims in 30 days or less--an improvement over fiscal year 1999, when 91 percent of claims were processed in 30 days or less. Although DOD and its MCS contractors have made changes to improve claims processing, some DOD procedures and inaccuracies in its data continue to create inefficiencies in TRICARE claims processing. Some DOD procedures may create inefficiencies by inadvertently increasing the demand for customer service, which claims processors are required to provide. Additionally, inaccuracies in DOD eligibility data--data that are needed to process TRICARE claims--can contribute to claims processing delays or rework if, for example, claims must be reprocessed when errors are identified. Finally, some DOD procedures lead to rework for claims processors, either in the form of reprocessing claims or reprogramming processing software. For example, when DOD makes program changes to TRICARE to alter or create a health benefit, it does not adhere to any schedule. In 2002, DOD made 123 program changes on 19 different dates throughout the year. Given the fact that implementing these changes often involves reprogramming and testing processing software, this approach can create rework for claims processors when DOD issues similar or related changes on separate occasions.

Download or read book Defense Health Care written by U S Government Accountability Office (G and published by BiblioGov. This book was released on 2013-06 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: Under TRICARE, the Department of Defense's (DOD) managed care program, military-operated hospitals and clinics are supplemented by contracted civilian services. Since the inception of TRICARE, DOD has made many changes to these contracts via contract change orders. Since July 1997, when GAO reported that DOD was trying to improve its change order process, the backlog of change orders has continued to grow. This report evaluates (1) the status of the change order backlog and how DOD addressed it, (2) factors that contributed to the growth of the backlog, and (3) DOD's new initiative to improve the change order process. GAO found that as of June, 2000, the number of change orders issued had almost tripled, while the number of unsettled change orders had more than doubled since July 1997. Despite recommendations to devote high-level attention to managing improvements to the change order process, this was not done. Until recently, none of TRICARE Management Activity's (TMA) many initiatives significantly improved the process or reduced the backlog. The current small backlog is the result of recent concerted effort, not better management over time. TMA's new Change Management Process (CMP) appears to address many of TMA's problems with change orders. However, past initiatives have made similar promises and delivered little when they were abandoned or eclipsed by higher priorities. The high volume of change orders now or soon to enter the new CMP makes it imperative that TMA management closely monitor the process to prevent future backlogs.

Download or read book Defense health care TRICARE resource sharing program failing to achieve expected savings report to the chairman and ranking minority member Subcommittee on Military Personnel Committee on National Security House of Representatives written by and published by DIANE Publishing. This book was released on with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book TRICARE Managed Care Support Contracts written by United States. Congress. House. Committee on Armed Services. Subcommittee on Military Personnel and published by . This book was released on 2001 with total page 270 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Defense Health Care written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-10-18 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: Defense Health Care: TRICARE Claims Processing Has Improved but Inefficiencies Remain

Download or read book Hearings on National Defense Authorization Act for Fiscal Year 1999 H R 3616 and Oversight of Previously Authorized Programs Before the Committee on National Security House of Representatives One Hundred Fifth Congress Second Session written by United States. Congress. House. Committee on National Security. Military Personnel Subcommittee and published by . This book was released on 1998 with total page 1060 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Implementation of TRICARE Benefits for Medicare Eligible Military Beneficiaries written by United States. Congress. House. Committee on Armed Services. Subcommittee on Military Personnel and published by . This book was released on 2001 with total page 824 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Major Management Challenges and Program Risks written by and published by . This book was released on 1999 with total page 84 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Budget Issues written by United States. General Accounting Office and published by . This book was released on 1999 with total page 280 pages. Available in PDF, EPUB and Kindle. Book excerpt: