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GAO Finds That Medicare Coverage Varies Greatly by Geographical Area

GAO Finds That Medicare Coverage Varies Greatly by Geographical Area

WASHINGTON--In testimony before the House Small Business Subcommittee chaired by Rep. Ron Wyden (D-Ore), the US General Accounting Office (GAO) said that Medicare beneficiaries may be denied reimbursement for certain x-rays and other diagnostic tests, depending on where they live.

For example, a patient living in Illinois is 1,400 times more likely to be denied payment for blood tests on the grounds that they are not medically necessary than one living in northern California. In addition, that Illinois patient is 900 times more likely to be denied reimbursement for a chest x-ray than one living in Wisconsin.

Rep. Wyden called for a more logical system of determining Medicare reimbursement guidelines. He called the Health Care Financing Administration (HCFA)'s current practice a "crazy quilt of separate and dramatically different rules."

Medicare payments for physician services are determined by 34 insurance companies under contract to HCFA. They sort, evaluate, and pay medical bills, guided by their own policies, not by a uniform rule established by the federal government.

 
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