Consolidation of Medicare claims processing at regional centers is planned under Medicare's new standardized claims processing system, but other functions such as audits, customer service and medical reviews are expected to continue to be performed by intermediaries.
The new program, called the Medicare Transaction System, will standardize Medicare claims and data, which currently are split among 13 systems, into one national system. It will cover not only the Medicare fee-for-service sector but also managed-care plans.
When implemented, hospitals will be able to file Medicare claims-the majority of them electronically-directly with HCFA. Another benefit of the change being touted by HCFA officials will be a standardized, nationwide database for managing quality and utilization information that will be comparable no matter what delivery system a beneficiary enrolls in.
The program, in development since the early 1990s, is expected to begin implementation in fall 1997, according to Cathy Carter, HHS deputy office director for analysis and systems. It will be about two years before it is fully in place, Carter added.
According to HCFA estimates, the new system will process more than a billion claims and pay nearly $300 billion in benefits by 2000. It will save about $200 million a year when fully implemented, according to HCFA estimates.
Late last week, HCFA was scheduled to release for the first time details of the new system in the form of a call for proposals from companies that wish to serve as transaction processors.
There are currently about 70 claims processors. Under the new program, the processing will be done on a regional basis. However, Carter said HCFA had not determined how many processors would be used.
Last November, two congressional panels held hearings to gauge the progress of the project amid concerns by GOP House members that HCFA would not deliver the project on time.
At that time, a General Accounting Office official testified that the project was moving along on schedule but criticized HCFA for not tracking the project's cost or defining its goals.