Medicare Payments: Use of Revised 'Inherent Reasonableness' Process GenerallyAppropriate

摘要

In 1998, Medicare paid at least $5.9 billion for medical equipment and supplieson behalf of beneficiaries who live at home or in long-term-care facilities such as nursing homes. Generally, Medicare uses a fee schedule to determine the amount it will pay for most medical equipment and supplies. Even when Medicare paid more than market prices for certain medical equipment and supplies, the Health Care Financing Administration (HCFA)--the agency that administers the Medicare program--had almost never adjusted payment amounts. This was because the process imposed by statute for changing unreasonably high or low Medicare payments, called the inherent reasonableness process, was slow and cumbersome and not even available for some items, such as surgical supplies.