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Durable Medical Equipment: Regional Carriers' Coverage Criteria Are Consistent with Medicare Law

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Report Type Reports and Testimonies
Report Date Sept. 19, 1995
Report No. HEHS-95-185
Subject
Summary:

In November 1993, the Health Care Financing Administration began consolidating the work of processing and paying claims for durable medical equipment, prostheses, orthoses, and supplies at four regional carriers. Claims for such items had previously been processed and paid by local Medicare carriers. As part of the transition to regional processing, the four regional carriers developed coverage criteria for the items. GAO found that the final criteria adopted by the regional carriers are consistent will Medicare's national coverage policies and the law. GAO does not believe that the criteria have impeded disabled beneficiaries access to needed durable medical equipment and other items. Also, in 1994 the regional carriers approved a similar percentage of service for durable medical equipment and other items for disabled and aged and aged Medicare beneficiaries, so there was no significant difference in access to durable medical equipment and other items between the two groups of beneficiaries.

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