Academic journal article Health Care Financing Review

Medicare Contractor Performance Evaluation Process Restructured to Stress Flexibility

Academic journal article Health Care Financing Review

Medicare Contractor Performance Evaluation Process Restructured to Stress Flexibility

Article excerpt

To meet expectations of the National Performance Review and to foster a total quality environment in Medicare operations, HCFA has revamped its process for evaluating Medicare fiscal intermediaries and carriers.

In FY 1995, HCFA's BPO convened staff from Central Office, Regional Offices, and OIG to restructure Medicare contractor performance evaluation into five criteria which describe performance expectations against which HCFA will evaluate Medicare contractor performance. The new approach is a proactive one which incorporates review flexibility, continuous improvement, and customer focus into the evaluation process.

The restructured evaluation program affords HCFA Regional Offices and Central Office the flexibility to review a contractor's performance in any and all aspects of its contractually required duties. This approach gives HCFA evaluators greater flexibility in determining the appropriate types and levels of review for contractors on an individual basis. Each criterion provides for primary data analysis which will result in indicators that will aid in determining the degree of performance evaluation required for a specific contractor.

The new evaluation approach serves to promote continuous improvement in contractors' Medicare operations. HCFA's performance expectations are designed to encourage contractors to focus on good service and improved performance in all aspects of contractor operations. …

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