Senate committee to reintroduce bill targeting Medicare audits, appeals

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CMI also urged Congress to permit recovery audit contractors to review claims before they are paid.
CMI also urged Congress to permit recovery audit contractors to review claims before they are paid.

A bill aimed at expediting the Medicare appeals process is expected to be reintroduced in the coming months, according to one healthcare insider.

The Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act, first introduced in late 2015, would add more resources to the Office of Medicare Hearing and Appeals to help combat the growing backlog of Medicare claim appeals. The original version of the bill pledged $125 million to OMHA, and $2 million to the Departmental Appeals Board of the Department of Health and Human Services, to fund reviews, hearings and appeals.

Kimberly Brandt, chief oversight counsel for the Senate Finance Committee's majority staff, told attendees at the Health Care Compliance Association's Compliance Institute on Tuesday that it's likely the committee will revive the bill in the near future, according to Bloomberg BNA.

The bill's reintroduction would be timely, since HHS has recently indicated that the backlog — which is expected to hit 1 million appeals in the next five years — can't be fixed by the 2021 deadline.

The AFIRM act also would tackle the issue of claim denials from Recovery Audit Contractors, which has been identified as a possible driver of the backlog. The bill would encourage coordination between Medicare contractors such as RACs, Medicare Audit Contractors and the Zone Program Integrity Contractors — something that isn't currently happening, Brandt noted.

The Council for Medicare Integrity introduced its own push for changes to the RAC program on Wednesday by requesting that Congress mandate a prepayment RAC program to review claims before they're paid. Such a program would help catch errors and prevent billions in improper payments each year, and alleviate provider burden, the group said.

A prepayment program would help identify errors stemming from misbilled claims — those billed with the wrong code, submitted as duplicates or submitted for services that weren't medically necessary. Over the past four year, such misbilled claims have cost Medicare more than $166 billion.

“It's more important than ever that Medicare improper payments are drastically reduced,” said Kristin Walter, spokeswoman for CMI. “If Recovery Auditors are permitted to review Medicare claims before they are paid, they could prevent Medicare from hemorrhaging billion in taxpayer dollars each year, reduce provider-perceived audit burden and ultimately, extend the life of this vital healthcare program for future beneficiaries.”