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HR 1250 113th Congress House Health Accounting and auditing Administrative law and regulatory procedures Administrative remedies Department of Health and Human Services Government information and archives Health facilities and institutions Health personnel Home and outpatient care Hospital care Judicial review and appeals Legal fees and court costs Long-term, rehabilitative, and terminal care Medicare Nursing Performance measurement Public contracts and procurement

Medicare Audit Improvement Act of 2013

Introduced: July 30, 2013 Introduced by: Graves, Sam Republican · Missouri See on congress.gov
This bill died when the 113th Congress ended
It never became law before the 113th Congress (2013–2014) adjourned, and bills don't carry over to the next Congress. It would have to be reintroduced. You can still save it for reference, but it won't receive updates.
 Everywhere this bill has been 4 steps
Introduced
In committee
Reported out
Passed House
Passed Senate
To President
Became law
Apr 22, 2013
Referred to the Subcommittee on Health.
Mar 22, 2013
Referred to the Subcommittee on Health.
Mar 19, 2013
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Mar 19, 2013
Introduced in House
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 Plain-English summary Congressional Research Service

Medicare Audit Improvement Act of 2013 - Directs the Secretary of Health and Human Services (HHS) to establish a process which subjects to a single, combined maximum annual limit, applied incrementally, the number of additional documentation requests made to a hospital by Medicare administrative contractors, recovery audit contractors, or Comprehensive Error Rate Testing (CERT) program contractors pursuant to prepayment and postpayment audits requiring a hospital to submit a medical record for audit purposes.

Directs the Secretary also to establish a distinct additional documentation request limit, computed according to a specified formula, for each hospital claim type for each hospital for a 45-day period in a year.

Amends title XVIII (Medicare) of the Social Security Act with respect to the Medicare Integrity Program and use of recovery audit contractors.

Requires the Secretary to ensure that recovery audit contracts include certain mandatory terms and conditions pertaining to: (1) penalties for certain compliance failures, (2) penalties for overturned appeals, (3) postpayment and prepayment audits, and (4) guidelines for prepayment review.

Directs the Secretary to publish on the Internet website of the Centers for Medicare & Medicaid Services information on recovery audit contractor performance regarding: (1) audit rates, denials, and appeals outcomes; and (2) independent performance evaluations.

Deems to be an original claim for Medicare part B (Supplementary Medical Insurance) payment a resubmitted hospital claim for Medicare part A payment for inpatient hospital services which a recovery audit contractor determines: (1) were not medically necessary and reasonable based on the site of service, but (2) would be medically necessary and reasonable in an outpatient setting of the hospital. Requires payment to be made for such a resubmitted claim for all furnished items and services for which payment may be made under Medicare part B.

Deems to be a reopened claim, for purposes of a hospital's ability to resubmit a claim for Medicare payment in timely fashion, any claim that is the subject of an audit by a recovery audit contractor or a Medicare administrative contractor.

Requires contracts for a recovery audit contractor to require that a physician review each denial of a claim for medical necessity made by an employee of the contractor who is not a physician.

Subjects to administrative and judicial review the Secretary's compliance with guidelines for reopening and revising benefit determinations.

What's happening now April 22, 2013

Referred to the Subcommittee on Health.

 Related & companion bills 1
 Bill text 1 version

Source documents hosted by congress.gov.

 Committees of jurisdiction 4
 Cosponsors 214
D
Foster, Bill
Illinois · Dec 8, 2014
BARTON, JOE
· Nov 13, 2014
Lamborn, Doug
· Sep 18, 2014
Miller, Jeff
· Sep 18, 2014
Sinema, Kyrsten
· Sep 8, 2014
R
Aderholt, Robert B.
Alabama · Jul 30, 2014
LOWEY, NITA
· Jul 15, 2014
Brooks, Mo
· Jul 8, 2014
Shea-Porter, Carol
· Jul 8, 2014
Chaffetz, Jason
· Jun 9, 2014
Davis, Rodney
· Jun 9, 2014
Kuster, Ann
· May 30, 2014
Lujan Grisham, Michelle
· May 28, 2014
R
Scalise, Steve
Louisiana · May 22, 2014
ROS-LEHTINEN, ILEANA
· May 21, 2014
Pearce, Stevan
· May 20, 2014
D
Schneider, Bradley Scott
Illinois · May 9, 2014
Ellison, Keith
· May 8, 2014
Rice, Tom
· May 8, 2014
R
Diaz-Balart, Mario
Florida · May 7, 2014
Gabbard, Tulsi
· May 7, 2014
FRELINGHUYSEN, RODNEY
· May 6, 2014
Fortenberry, Jeff
· Apr 30, 2014
Messer, Luke
· Apr 28, 2014
D
Quigley, Mike
Illinois · Apr 28, 2014
D
Clark, Katherine M.
Massachusetts · Apr 8, 2014
R
Cole, Tom
Oklahoma · Mar 25, 2014
Westmoreland, Lynn
· Mar 24, 2014
Butterfield, G. K.
· Mar 11, 2014
Ross, Dennis
· Mar 11, 2014
Dent, Charles
· Mar 5, 2014
Byrne, Bradley
· Mar 4, 2014
D
Sewell, Terri A.
Alabama · Mar 4, 2014
COBLE, HOWARD
· Feb 28, 2014
Hanabusa, Colleen
· Feb 28, 2014
Vela, Filemon
· Feb 28, 2014
D
Keating, William R.
Massachusetts · Feb 27, 2014
Sires, Albio
· Feb 27, 2014
D
Johnson, Henry C. "Hank"
Georgia · Feb 25, 2014
D
Moore, Gwen
Wisconsin · Feb 25, 2014
Bucshon, Larry
· Feb 21, 2014
R
Carter, John R.
Texas · Feb 21, 2014
CRENSHAW, ANDER
· Feb 21, 2014
Fudge, Marcia
· Feb 10, 2014
R
Lummis, Cynthia M.
Wyoming · Feb 5, 2014
GREEN, GENE
· Feb 4, 2014
R
Joyce, David P.
Ohio · Feb 4, 2014
R
Perry, Scott
Pennsylvania · Jan 27, 2014
D
Swalwell, Eric
California · Jan 16, 2014
D
Beatty, Joyce
Ohio · Jan 15, 2014
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APA
U.S. Congress. (2026). H.R. 1250: Medicare Audit Improvement Act of 2013. 113th Congress. Open America. https://openamerica.io/bill/113-HR-1250/
MLA
"H.R. 1250: Medicare Audit Improvement Act of 2013." 113th Congress, 2026, Open America, https://openamerica.io/bill/113-HR-1250/.
Bluebook (legal)
H.R. 1250, 113th Cong. (2026), https://openamerica.io/bill/113-HR-1250/.
Markdown link
[H.R. 1250: Medicare Audit Improvement Act of 2013](https://openamerica.io/bill/113-HR-1250/)
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