Bill > S1012

This bill, titled the Medicare Audit Improvement Act of 2013, aims to enhance the operations of recovery auditors, which are contractors that review Medicare claims to ensure payments are correct, by increasing transparency and accuracy in their audits. Key provisions include establishing limits on the number of additional documentation requests Medicare contractors can make to hospitals, improving recovery auditor performance by imposing penalties for missed deadlines or untimely communication and requiring them to pay fees for overturned appeals, and mandating that audits focus on widespread payment errors rather than isolated issues. The bill also seeks to increase transparency by requiring the annual publication of detailed performance data for recovery auditors, including audit rates, denial rates, and appeal outcomes. Furthermore, it ensures that if a hospital's inpatient services are denied for not being medically necessary but are found to be medically necessary at an outpatient level, the claim can be resubmitted as an original claim for payment under Medicare Part B, and it requires that medical necessity denials made by non-physician reviewers be validated by a physician. Finally, the bill ensures due process by making the Secretary's adherence to guidelines for reopening and revising determinations subject to administrative and judicial review.