Download or read book Stronger Management Needed to Improve Employee Organization Health Plans Payment Practices written by United States Accounting Office (GAO) and published by Createspace Independent Publishing Platform. This book was released on 2018-06-26 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt: Stronger Management Needed To Improve Employee Organization Health Plans' Payment Practices

Download or read book Stronger management needed to improve employee organization health plans payment practices written by United States. General Accounting Office and published by . This book was released on 1979 with total page 65 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Office of Personnel Management (OPM) has not done an effective job of guiding and overseeing the Employee Organization Plans participating in the Federal Employees Health Benefits program. OPM has allowed the plans to make claim payments without determining whether the claims represented sound comprehensive systems to determine the reasonableness of charges as the contracts require. The Plans have paid claims without having information necessary to demonstrate medical necessity. Paid claims were found that: (1) appeared to represent noncovered routine physical examinations; (2) had been paid with no indication of symptoms or diagnoses; (3) had diagnoses or symptoms that were not clearly related to the tests provided; (4) were for hospitalizations that appeared either unnecessary or too long; and (5) were paid as emergencies when the patients' diagnoses did not indicate emergencies. The Plans' payment system did not fully comply with the contracts. The Plans are required to develop reasonable charge allowances and pay only up to those amounts except in unusual circumstances. OPM has been aware of some of these problems, but it has provided little formal guidance to help the plans determine medical necessity or reasonable allowances.

Download or read book Employment written by U S Government Accountability Office (G and published by BiblioGov. This book was released on 2013-06 with total page 78 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Office of Personnel Management (OPM) has not done an effective job of guiding and overseeing the Employee Organization Plans participating in the Federal Employees Health Benefits program. OPM has allowed the plans to make claim payments without determining whether the claims represented sound comprehensive systems to determine the reasonableness of charges as the contracts require. The Plans have paid claims without having information necessary to demonstrate medical necessity. Paid claims were found that: (1) appeared to represent noncovered routine physical examinations; (2) had been paid with no indication of symptoms or diagnoses; (3) had diagnoses or symptoms that were not clearly related to the tests provided; (4) were for hospitalizations that appeared either unnecessary or too long; and (5) were paid as emergencies when the patients' diagnoses did not indicate emergencies. The Plans' payment system did not fully comply with the contracts. The Plans are required to develop reasonable charge allowances and pay only up to those amounts except in unusual circumstances. OPM has been aware of some of these problems, but it has provided little formal guidance to help the plans determine medical necessity or reasonable allowances.

Download or read book Improve Payment Practices of Employee Organization Health Plans written by United States. Congress. House. Committee on Post Office and Civil Service. Subcommittee on Compensation and Employee Benefits and published by . This book was released on 1980 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book GAO Documents written by United States. General Accounting Office and published by . This book was released on 1981 with total page 916 pages. Available in PDF, EPUB and Kindle. Book excerpt: Catalog of reports, decisions and opinions, testimonies and speeches.

Download or read book Treasury Postal Service and General Government Appropriations for Fiscal Year 1994 Administrative Conference of the United States written by United States. Congress. House. Committee on Appropriations. Subcommittee on the Treasury, Postal Service, and General Government Appropriations and published by . This book was released on 1993 with total page 1284 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Personnel Literature written by United States. Office of Personnel Management. Library and published by . This book was released on 1981 with total page 726 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Health bibliography written by and published by . This book was released on 1981 with total page 306 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Monthly Catalog of United States Government Publications written by and published by . This book was released on 1981 with total page 360 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Monthly Catalogue United States Public Documents written by and published by . This book was released on 1981 with total page 748 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Analysis of the Grace Commission s Major Proposals for Cost Control written by and published by . This book was released on 1984 with total page 420 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book OPM Should Promote Medical Necessity Programs for Federal Employees Health Insurance written by United States. General Accounting Office and published by . This book was released on 1980 with total page 82 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Financial and Other Problems Facing the Federal Employees Health Insurance Program written by United States. General Accounting Office and published by . This book was released on 1983 with total page 76 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Legislative Review of the Committee on Post Office and Civil Service House of Representatives During the Ninety sixth Congress First Session written by United States. Congress. House. Committee on Post Office and Civil Service and published by . This book was released on 1980 with total page 96 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book The Personnel Management Function written by United States. Office of Personnel Management. Library and published by . This book was released on 1981 with total page 80 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Personnel Management Function written by United States. Office of Personnel Management and published by . This book was released on 1981 with total page 80 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Annual Report Comptroller General of the United States written by United States. General Accounting Office and published by . This book was released on 1979 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt: