Long-term care providers would receive more education from auditors under draft Medicare bill

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Medicare auditors would boost outreach and education efforts to long-term care and other providers under the provisions of a draft bill introduced Thursday by Rep. Kevin Brady (R-TX), chairman of the Ways and Means health subcommittee.

The “Protecting Integrity in Medicare Act (PIMA) of 2014” calls for Medicare Administrative Contractors to create formal programs to furnish providers with training and other assistance. It would include general information — for example, notices of new topics that have been approved for audits — as well as facility-specific information such as the most frequent and expensive payment errors. Recovery Audit Contractors would assist in this effort by furnishing MACs with information about providers' improper payment rates.

Providers and regulators both have protested that the current system of catching and reducing Medicare fraud and improper payments is too focused on post-payment actions, rather than educating providers to avoid issues.

“The current system of pay-and-chase is clearly not working,” Brady stated. “Larger system changes are still needed, but the policies crafted here take steps to kick-start the process.”

Some of the PIMA policies around provider education are based on proposals in an existing piece of bipartisan legislation known as the PRIME Act (Preventing and Reducing Improper Medicare and Medicaid Expenditures Act).

Removal of beneficiary Social Security numbers from Medicare cards, expansion of who can document face-to-face medical encounters for durable medical equipment prescriptions, and expanded authority to investigate and prosecute abuse/neglect claims in home health are among other PIMA provisions.

Click here to access the complete discussion draft.
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