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Medicare Audit Improvement Act of 2013

Introduced: March 19, 2013 Introduced by: Graves, Sam Republican · Missouri See on congress.gov
 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
 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.

 Committees of jurisdiction 4
 Cosponsors 74
D
Foster, Bill
Illinois · Dec 8, 2014
R
Aderholt, Robert B.
Alabama · Jul 30, 2014
R
Scalise, Steve
Louisiana · May 22, 2014
D
Schneider, Bradley Scott
Illinois · May 9, 2014
R
Diaz-Balart, Mario
Florida · May 7, 2014
D
Quigley, Mike
Illinois · Apr 28, 2014
D
Clark, Katherine M.
Massachusetts · Apr 8, 2014
R
Cole, Tom
Oklahoma · Mar 25, 2014
D
Sewell, Terri A.
Alabama · Mar 4, 2014
D
Keating, William R.
Massachusetts · Feb 27, 2014
D
Johnson, Henry C. "Hank"
Georgia · Feb 25, 2014
D
Moore, Gwen
Wisconsin · Feb 25, 2014
R
Carter, John R.
Texas · Feb 21, 2014
R
Lummis, Cynthia M.
Wyoming · Feb 5, 2014
R
Joyce, David P.
Ohio · Feb 4, 2014
R
Perry, Scott
Pennsylvania · Jan 27, 2014
D
Beatty, Joyce
Ohio · Jan 15, 2014
D
Pingree, Chellie
Maine · Dec 12, 2013
R
Webster, Daniel
Florida · Dec 9, 2013
R
Gosar, Paul A.
Arizona · Nov 21, 2013
R
Wilson, Joe
South Carolina · Nov 14, 2013
D
Pocan, Mark
Wisconsin · Nov 13, 2013
D
Himes, James A.
Connecticut · Oct 7, 2013
D
Cohen, Steve
Tennessee · Oct 4, 2013
R
Fleischmann, Charles J. "Chuck"
Tennessee · Oct 1, 2013
D
Bera, Ami
California · Sep 27, 2013
D
Cuellar, Henry
Texas · Sep 25, 2013
D
Thompson, Bennie G.
Mississippi · Sep 25, 2013
R
Massie, Thomas
Kentucky · Sep 20, 2013
R
Rogers, Harold
Kentucky · Sep 19, 2013
D
Veasey, Marc A.
Texas · Sep 17, 2013
D
Garamendi, John
California · Sep 12, 2013
R
Rogers, Mike D.
Alabama · Sep 12, 2013
D
Takano, Mark
California · Sep 12, 2013
D
Vargas, Juan
California · Sep 12, 2013
D
Wilson, Frederica S.
Florida · Sep 11, 2013
R
Smith, Jason
Missouri · Sep 9, 2013
D
Courtney, Joe
Connecticut · Aug 1, 2013
R
Williams, Roger
Texas · Jul 31, 2013
R
Womack, Steve
Arkansas · Jul 31, 2013
R
Latta, Robert E.
Ohio · Jul 30, 2013
D
Matsui, Doris O.
California · Jul 30, 2013
R
Weber, Randy K. Sr.
Texas · Jul 30, 2013
D
McGovern, James P.
Massachusetts · Jul 25, 2013
R
Daines, Steve
Montana · Jul 22, 2013
R
Barr, Andy
Kentucky · Jul 18, 2013
R
Cramer, Kevin
North Dakota · Jul 18, 2013
D
Neal, Richard E.
Massachusetts · Jul 18, 2013
R
Scott, Austin
Georgia · Jul 17, 2013
D
Cleaver, Emanuel
Missouri · Jul 10, 2013
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