Download or read book DOD Contractors Health Insurance Reimbursement written by United States. Congress. House. Committee on Government Operations. Legislation and National Security Subcommittee and published by . This book was released on 1988 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Dod contractors health insurance reimbursement written by and published by . This book was released on 1988 with total page 56 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Government Contractors written by United States. General Accounting Office and published by . This book was released on 1988 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Health Care Provided by Military Treatment Facilities to Contractors in Southwest Asia written by and published by . This book was released on 2009 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt: Contract terms for health care provided by military treatment facilities to contractors in Southwest Asia were not adequately addressed. Based on a statistical sample of 2,561 DoD contracts, we projected that 1,383, or 54 percent of the contracts had health care terms that were vague and subject to interpretation, or were silent on health care terms. Military treatment facilities were not billing and collecting payment from contractors for health care provided. DoD internal controls were inadequate. We identified a material internal control weakness in billing and collecting payments from contractors that receive health care from military treatment facilities in Southwest Asia. Military treatment facilities in Southwest Asia may have provided health care billable in the millions without seeking reimbursement. We did not project a potential monetary benefit.
Download or read book DOD Contractors Health Insurance Reimbursement written by United States. Congress. House. Committee on Government Operations. Legislation and National Security Subcommittee and published by . This book was released on 1988 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Government Contractors written by U S Government Accountability Office (G and published by BiblioGov. This book was released on 2013-06 with total page 132 pages. Available in PDF, EPUB and Kindle. Book excerpt: GAO evaluated government efforts to ensure that contractors' health care costs under negotiated contracts were reasonable, focusing on: (1) health care costs of selected government contractors compared to those of other manufacturing industries and the government work force; (2) the primary reasons for cost differences; and (3) the adequacy of federal internal controls over allowable compensation costs. GAO found that: (1) government health care costs under negotiated contracts were high because contractors required less cost-sharing from their employees compared with employees in the manufacturing industries; (2) only 1 of the 10 largest government contractors it reviewed required its employees to share in the cost of their health insurance premiums; (3) the government lacked adequate internal controls to ensure that reimbursements to contractors were reasonable; (4) 1986 revisions to the Federal Acquisition Regulation (FAR) did not specify the criteria for assessing the reasonableness of contractor compensation; and (5) during a 5-year period, the government reimbursed its 10 largest contractors about $4.5 billion for their employee health care costs.
Download or read book Defense Health Care written by United States. General Accounting Office and published by . This book was released on 1999 with total page 48 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 1999 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: Under TRICARE, the military's managed health care program, contractors adjudicate and pay health care claims submitted by civilian providers of care or the military personnel who receive it. The Defense Department's (DOD) timeliness standard requires the contractors to process 75 percent of claims within 21 days. Although contractors processed 86 percent of claims within 21 days between July 1997 and June 1998, GAO found that 3 million claims took more than 21 days, prompting complaints from providers and beneficiaries. To improve timeliness, DOD proposes to adopt standards similar to Medicare's. DOD does not know the extent to which the claims-processing contractors pay claims accurately, less than half of the claims are subject to audit, and the methodology DOD uses to calculate payment error is statistically invalid. Accuracy is affected by TRICARE's complexity and numerous changes and by mistakes providers and beneficiaries make when filing their claims. They sometimes complain about adjudication decisions on correctly processed claims. Some providers complain that the review criteria for the commercial software program DOD requires its contractors to use to ensure appropriate payment are not published and available to them. GAO found that the program's criteria are based on industry standards but that some inappropriate denials of claims have resulted from DOD's slowness in directing contractors to incorporate TRICARE policy changes into their claims-processing systems.
Download or read book Substance Use Disorders in the U S Armed Forces written by Institute of Medicine and published by National Academies Press. This book was released on 2013-03-21 with total page 350 pages. Available in PDF, EPUB and Kindle. Book excerpt: Problems stemming from the misuse and abuse of alcohol and other drugs are by no means a new phenomenon, although the face of the issues has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are particularly prominent within the military, a population that also continues to experience long-standing issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade-in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD). To better understand this problem, DoD requested that the Institute of Medicine (IOM) assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs). Substance Use Disorders in the U.S. Armed Forces reviews the IOM's task of assessing access to SUD care for service members, members of the National Guard and Reserves, and military dependents, as well as the education and credentialing of SUD care providers, and offers specific recommendations to DoD on where and how improvements in these areas could be made.
Download or read book Government Estimates in the Tricare Managed Care Support Contracts written by Michael Evi Jonasson and published by . This book was released on 2001-08-01 with total page 101 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 1994, the Department of Defense (DoD) began a journey, to merge the Military Health System (MHS) with the concept of the Managed Care Support Contractor (MCSC). The DoD managed health care program, called TRICARE, includes the competitive selection of contractors to financially underwrite the delivery of civilian health care services with a uniform, stabilized benefit structure, triple option health benefit features, and a regionally-based health care management system. The goals of TRICARE are to maintain medical readiness, improve access to care, provide a secure quality health care benefit, provide a choice of health care options, and contain DOD health care costs. The Managed Care Support (MCS) contracts are fixed-price contracts, with risk-sharing features and a bid price adjustment process designed to periodically substitute projected/estimated health care costs with actual health care costs. MCS contracts are 5 1/2 year contracts, with a 6-month phase-in period prior to start-up of delivery of health care services, followed by 5 1-year option periods. This thesis will explore the bid price adjustment process within the MCS contract, and the Government's methodology used to project/estimate health care costs for use by offerors in the bidding process. Selected as an example for discussion is the Regions 3 and 4 MCS contract. This thesis explores whether the Government, in choosing and engaging a methodology for projecting/estimating health care costs, should have instead chosen another methodology or path; i.e., "the road not taken."
Download or read book Defense Health Care written by U.s. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-08-08 with total page 56 pages. Available in PDF, EPUB and Kindle. Book excerpt: " DOD operates a large and complex health care system that employs more than 150,000 military, civilian, and contract personnel working in military treatment facilities. Each military department operates its own facilities, and contracts separately for health care professionals to supplement care provided within these facilities. In fiscal year 2011, these contracts totaled $1.14 billion. In the National Defense Authorization Act for Fiscal Year 2012, Congress mandated that GAO review the military departments' acquisition of health care professional services. This report examines (1) the contracting practices used by the departments and their cost effectiveness; (2) the extent to which the departments consolidate health care staffing requirements; (3) the percentage and associated costs of contract health care professionals working at on-base facilities versus offbase; (4) the training requirements for and experience of medical services contracting personnel; and (5) the extent to which the departments' policies address legislated quality standards for contract civilian health care professionals and for staffing companies that provide these professionals. To conduct this review, GAO reviewed military health care policies, analyzed DOD's fiscal year 2011 procurement and staffing data, and interviewed DOD military health system officials. "
Download or read book Health Care Finance and the Mechanics of Insurance and Reimbursement written by Michael K. Harrington and published by Jones & Bartlett Publishers. This book was released on 2015-02-27 with total page 370 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book addresses the methods and process for reimbursement, including coding, reimbursement strategies, compliance, financial reporting, case mix index, and external auditing. With up-to-date coverage of the Affordable Care Act, this text will prepare health administration and health information management students with the necessary tools to successfully transition from the classroom to the health care facility. Some of the topics covered include: claims processing; the Affordable Care Act; Medicare Prospective Payment System (Inpatient); Medicare Outpatient Prospective Payment Systems (Non-Inpatient); coding for the non-HIM professional; revenue cycle management; healthcare fraud and abuse; electronic health records and meaningful use; government incentive programs; recovery audit contractors student & instructor resources. --
Download or read book Defense Health Care written by Stephen P. Backhus and published by . This book was released on 1999 with total page 11 pages. Available in PDF, EPUB and Kindle. Book excerpt: During 1998, contractors processed about 28 million health care claims under TRICARE--the military's managed health care program. In eight of its 11 regions, TRICARE's contractors met the Defense Department's (DOD) standard by processing at least 75 percent of the claims on time. Even so, providers are concerned because millions of claims are not being paid promptly. The overall timeliness of contractors' performance masks weaker performance in processing certain specific claims, including those submitted by hospitals. It appears that most of the claims processing problems stem from poor DOD monitoring of and communication with its contractors. Furthermore, DOD's methodology for its payment accuracy audits is statistically unsound and does not accurately measure payment errors. Although the extent of error is unknown, contractors told GAO that TRICARE's inherent complexity also impedes claims processing accuracy. In addition, inappropriate denials are sometimes made because of DOD's poor communication and slowness to make changes that affect the outcomes of ClaimCheck, DOD's software for performing prepayment reviews of claims and preventing overpayments by analyzing the appropriateness of billing on professional claims. Providers are further frustrated because they mistakenly believe that they have no recourse for ClaimCheck denials. DOD and its contractors are trying to address some of these problems.
Download or read book Defense Health Care written by Government Accountability Office and published by . This book was released on 2017-08-25 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: "DOD offers health care coverage-medical and pharmacy services-to eligible beneficiaries through its TRICARE program. DOD contracts with managed care support contractors to provide medical services, and separately with a pharmacy benefit manager to provide pharmacy services that include the TRICARE mail-order pharmacy and access to a retail pharmacy network. This is referred to as a carve-out contract structure. DOD's current pharmacy contract ends in the fall of 2014. DOD has been preparing for its upcoming contract through acquisition planning, which included identifying any needed changes to contract requirements.Senate Report 112-173, which accompanied a version of the NDAA for fiscal year 2013, mandated that GAO review DOD's health care contracts. For this report, GAO examined: (1) how DOD identified changes needed, if any, to requirements for its upcoming pharmacy services contract; and (2) what, if any, assessment DOD has done of the appropriateness of its current contract structure. GAO reviewed DOD acquisition planning documents and federal regulations, and interviewed officials from DOD and its pharmacy services contractor."
Download or read book Reinsuring Health written by Katherine Swartz and published by Russell Sage Foundation. This book was released on 2006-05-11 with total page 220 pages. Available in PDF, EPUB and Kindle. Book excerpt: America's current system of health insurance, which relies almost exclusively on employer-sponsored coverage, is in danger of collapse, and this problem is not limited to the poor and working class. An increasing number of middle class Americans do not have employer-provided insurance and—due to skyrocketing premiums—cannot afford to purchase coverage for themselves. Reinsuring Health, by economist Katherine Swartz, examines this growing national crisis and outlines a concrete plan to make health insurance accessible and affordable for all Americans. Reinsuring Health documents why the number of uninsured Americans—now 45.5 million people—has grown in the last twenty-five years. Swartz focuses on how labor market changes—such as the decline of domestic manufacturing, decreased unionization, and the growth of non-standard work arrangements—have led U.S. employers to retreat from providing health insurance for their workers. These trends, combined with the increasing costs of medical care, have led to an explosion in health insurance premiums and a decline in coverage, particularly among the middle-class. Since those who seek insurance as individuals are generally most likely to need health care, private insurers charge higher premiums in the individual (non-group) markets than to people who obtain group insurance. This makes individual health insurance less attractive to the young and increasingly unaffordable for middle-class Americans. Similarly, insurers charge higher per person (or per family) premiums to small firms than to large companies, so many small firms do not sponsor coverage for their employees. Reinsuring Health shows how these problems can be overcome if the federal government provides a new reinsurance program which would protect insurance companies that provide small group and individual health insurance against the possibility that their policy-holders will incur very high medical expenses. By assuming some of the risk that people will face extremely costly medical bills, the government will make insurers less hesitant to offer coverage to high-risk individuals, and will help drive down premiums for others. Reinsuring Health demonstrates that this form of government reinsurance has worked in the past, helping to establish smooth running private markets for catastrophe insurance and secondary mortgages. Today, growing numbers of middle class Americans lack health insurance. Protection against the possibility of falling ill or getting hurt and having to pay extraordinary health care bills should not be a luxury available only to the very rich and the very poor. Reinsuring Health proposes a straightforward solution that would bring health insurance back within the reach of the increasing ranks of the uninsured, particularly those who are in the middle class.
Download or read book The Defense Base Act DBA The Federally Mandated Workers Compensation System for Overseas Government Contractors written by and published by . This book was released on 2010 with total page 33 pages. Available in PDF, EPUB and Kindle. Book excerpt: Many overseas federal contractors are covered by the Defense Base Act (DBA), which mandates that they provide workers' compensation insurance for their employees. As the U.S. military has increased operations in Iraq, the size of the DBA program has grown. Since September 2001, there have been 49,472 DBA cases, including 1,584 cases involving the deaths of contractors in Iraq and Afghanistan. Nearly $200 million in cash and medical benefits were paid to DBA claimants in 2008. Congress has become increasingly concerned with the costs involved in the DBA program because the federal government usually reimburses its contractors for their DBA premiums. The Department of State (DOS) and the U.S. Agency for International Development (USAID) have seen some cost savings since adopting single-source models for their DBA insurance in which contractors for each agency are required to purchase insurance from a single company selected by the agency. The U.S. Army Corps of Engineers (USACE) is currently testing such a model for its DBA system. For the rest of the Department of Defense (DOD), however, including the Army's large Logistics Civil Augmentation Program (LOGCAP) contract, individual contractors are free to select their own DBA insurers and negotiate their own rates, and one contractor, KBR, has been criticized by DOD auditors for failing to demonstrate that it sought to control DBA premium costs when selecting an insurer. The Duncan Hunter National Defense Authorization Act (NDAA) for FY2009 (P.L. 110-417) includes a provision that requires DOD to change the way its contractors provide DBA coverage for their workers. In a report issued pursuant to this legislation, DOD concluded that making improvements to the current open-market DBA insurance system would best meet the criteria for reform recommended by Congress and the agency.
Download or read book Health Benefits Coverage Under Federal Law written by and published by . This book was released on 2010 with total page 108 pages. Available in PDF, EPUB and Kindle. Book excerpt:
