Bill would limit Medicare claim reviews for trusted providers

Share this content:
Report: Long-term care providers pay the price for CMS' poor auditor oversight
Report: Long-term care providers pay the price for CMS' poor auditor oversight

A bill in the House of Representatives aims to create a “trusted provider” status in the Medicare program, which would potentially streamline the reimbursement and claims review processes for some long-term care operators.

In its quest to fight Medicare fraud and abuse, the government should not punish above-board providers, according to Rep. Roger W. Williams (R-TX). He introduced the “Medicare Established Provider Act” to cut down on a reimbursement backlog by identifying providers that are at low risk for fraud.

“In order to maintain Established Provider System status, providers of services and suppliers must hold a success rate of 75% for all claims,” Williams wrote in a letter to House colleagues that was emailed to McKnight's this week.

The preferred providers would be subject to periodic reviews, but would benefit from faster reimbursement and limited timeframes for the “reconsideration process,” according to Williams.

Medicare Administrative Contractors are already processing 1.2 billion claims a year, and this number is set to rise, Williams noted. He said it is “no surprise” that the Government Accountability Office recently found that outpatient therapy is a high-risk area for fraud and inappropriate payments, but said this is not a good reason to “blindly” cast a net over all providers.

Click here to see the text of the bill.