The effectiveness of Medicare Part B medical review: issues and alternatives.
The part B medical review methods currently used by Medicare carriers to control resource use suffer from a series of problems including failure to reward deterrence of unnecessary claims, failure to detect substitution of nonreviewed claims, reliance on average rather than marginal measures of performance, excessive focusing of reviews, and the inability to measure effectiveness separately from the intervention. This article describes these problems and proposes a series of alternative strategies for review that may improve these problems.
Nyman
J A
JA
Institute for Health Services Research, University of Minnesota, Minneapolis, USA.
Hillson
S
S
D003362:Cost-Benefit Analysis; D005069:Evaluation Studies as Topic; D017408:Guidelines as Topic; D007343:Insurance Carriers / Q000331:legislation & jurisprudence / Q000592:standards*; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence / Q000592:standards* / Q000706:statistics & numerical data; D016345:Medicare Part B / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017146:Models, Organizational; D011057:Politics; D014481:United States