Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, January 20, 1994 TAG: 9401200118
SECTION: NATIONAL/INTERNATIONAL PAGE: A-9 EDITION: METRO
SOURCE: Associated Press
DATELINE: WASHINGTON LENGTH: Medium
"Words like hassle, paperwork and frustration will no longer be part of the Medicare vocabulary for millions of America's senior citizens," Health and Human Services Secretary Donna Shalala promised at a news conference Wednesday.
She announced the award of a $19 million, six-year contract to GTE Government Systems Corp. of Chantilly, Va., to launch the new Medicare Transaction System. It will come on line starting in late 1996 and be complete by late 1998.
By centralizing claims handling now done by 79 separate Medicare contractors with 14 different computer systems, the government hopes to save more than $200 million a year.
The system now is "a modern-day maze for patients and for professionals, and everybody has a nightmare story about getting lost in it," said Shalala, who added that she cannot get on an airplane without hearing somebody's complaint.
The new system will give doctors, hospitals, laboratories and nursing homes instant information about a patient's eligibility, prior claims and Medigap or other private coverage.
It will be able to pay the provider automatically and simultaneously bill a Medigap plan for the rest of the patient's bill.
Instead of getting a hard-to-understand "explanation of benefits" form for every service a doctor performs, the elderly might get a monthly or quarterly statement from Medicare along the lines of a bank or credit-card statement, said Bruce C. Vladeck, head of the Health Care Financing Administration.
The new system will know whether a patient has met the yearly Medicare deductible for hospital care, even if he or she was treated before in a different part of the country.
The new system also will help the government keep a sharper watch for crooks who file fake or padded claims with different Medicare contractors, said Vladeck.
By the year 2000, the system will be handling 1 billion claims a year for the nation's 36 million elderly or disabled Medicare beneficiaries.
Vladeck said there still will be a role for the local Medicare contractors - many of them Blue Cross plans and other private insurers - but it will be more customer service than data processing work.
The Health Care Financing Administration expects virtually all Medicare claims to be submitted electronically by 1998, and to pay providers by electronic fund transfers to their bank accounts.
Already the nation's 5,500 hospitals and one-third to one-half of all doctors bill Medicare electronically, Vladeck said.
by CNB