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
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.