• Medicare Audit Improvement Act of 2013 (H.R. 1250)

    Wednesday April 24, 2013

    Medicare Audit Improvement Act of 2013 (H.R. 1250)
    Legislation has been introduced that would make much-needed improvements to the Recovery Audit Contractor (RAC) program and other Medicare audit programs. Representatives Sam Graves (R-MO) and Adam Schiff (D-CA) introduced the Medicare Audit Improvement Act of 2013 (H.R. 1250), which, among other measures, would:

    • Establish a consolidated limit for medical record requests
    • Improve auditor performance by implementing financial penalties and by requiring medical necessity audits to focus on widespread payment errors
    • Improve recovery auditor transparency
    • Assure due process appeals for claims reopenings
    • Allow accurate payment for rebilled claims
    • Require physician review for Medicare denials

    In a separate move, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on March 13, 2013, that would allow hospitals to be paid full Part B (outpatient) payment for inpatient claims denied during a RAC audit, when the care is found to be appropriate at the outpatient level, if the claim is one year old or less. This time limitation is particularly problematic to hospitals considering RACs audit claims for services provided during the previous three years. The Medicare Audit Improvement Act of 2013 (see above) would fix this Part B underpayment policy.

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