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New Bill Aims to Ensure Medicare Payment Accuracy and Reduce Red Tape

Congressman Adrian Smith (R-NE), along with 13 co-sponsors, introduced a new bill on June 12, 2013, titled the Administrative Relief and Accurate Medicare Payments Act of 2013. This initiative, House Rule (H.R.) 2329, aims to ease administrative burdens on healthcare providers and efficiently allocate energy and resources related to Medicare payment and audits.

In addition to addressing the concerns of administrative burdens and short timeliness-of-filing requirements, the bill also seeks to improve payment accuracy. By increasing the filing period for claims and making other changes to streamline the appeals process, the Act is designed to ease the burden on hospitals.

In a press release, Congressman Smith announced,

While strong oversight of Medicare payments is essential to prevent waste and fraud, the current process is overly-burdensome and time consuming… I introduced the Administrative Relief and Accurate Medicare Payments Act as a first step to reduce the red tape for providers while ensuring payments are accurate. This commonsense solution would allow hospitals and doctors to focus more resources providing quality care for their patients, and spend less time dealing with the Medicare bureaucracy.

In March 2013, CMS released a Proposed Rule which, should it become final in its current form, provides hospitals the ability to rebill under Medicare Part B when an inpatient admission is denied as not reasonable and necessary under Part A so long as the claim is rebilled within one year from the date of service. H.R. 2329 seeks to amend title XVIII of the Social Security Act by providing for a maximum period of two years for Medicare Part B claim submissions initially submitted as Medicare Part A claims by hospitals. The Act proposes, amongst other purposes, a 60-day maximum period for one-day stay claims. H.R. 2329 has been referred to the Committee on Energy and Commerce, as well as the Committee on Ways and Means to determine whether the Act’s provisions fall within the committees’ jurisdictions.

H.R. 2329 is a lean version of a bill that has been traveling through the House with Congressmen Sam Graves (R-MO) and Adam Schiff (D-CA), titled the Medicare Audit Improvement Act of 2013. The Medicare Audit Improvement Act of 2013 has a similar goal: to help small hospitals that may be ill-equipped to handle extensive document requests. This Act seeks to put a cap on the amount of document requests that Recovery Audit Contractors (RACs) may demand from providers.

Although RACs have successfully recovered millions of dollars in improper Medicare payments to health care providers, this Act may be valuable to hospitals struggling with the administrative burdens created by RAC audits. A thorough compliance plan is essential for hospitals seeking to decrease the risk of receiving an audit. If you or your healthcare entity needs assistance in developing an effective compliance plan, or assistance in Medicare, Medicaid, or third party payer audit defense, please contact our experienced health care attorneys at 248-544-0888.